M2I0 A KM I oERVICE FORCES MANUAL OPERATING1 FRUCEOURES FOR INDUSTRIAL DISPENSARIES HEADQUARTERS. ARMY SERVICE FORCES. MARCH 1945 ARMY SERVICE FORCES MANUAL M210 Personnel OPERATING PROCEDURES FOR INDUSTRIAL DISPENSARIES Headquarters, Army Service Forces. March 1945 United States Government Printing Office, Washington; 1945 NUMBERING SYSTEM OF ARMY SERVICE FORCES MANUALS The main subject matter of each Army Service Forces Manual is indicated by consecutive numbering within the following categories: M1-M99 Basic and Advanced Training M100-M199 Army Specialized Training Program and Pre-Induction Training M200-M299 Personnel and Morale M300-M399 Military Law and Enforcement, Organizations, Civil Affairs M400-M499 Supply and Transportation M500-M599 Fiscal M600-M699 Procurement and Production M700-M799 Administration M800-M899 Miscellaneous M900 up Equipment, Materiel, Housing and Construction HEADQUARTERS, ARMY SERVICE FORCES Washington 25, D. C., 17 March 1945 Army Service Forces Manual M210, Operating Procedures for Industrial Dispensaries, has been prepared under the supervision of The Surgeon General, and is published for the infor- mation and guidance of all concerned. [SPX 300.7 (14 Dec 44)] command of Lieutenant General SOMERVELL Official : J. A. ULIO Ma jor General The Adjutant General Distribution : W. D. STYER Lieutenant General U.S.A. Chief of Staff AAF (5) ; AGF (5) ; ASF (2) ; T of Opns (3) ; Def Comd (3) ; Tech Sv (3) ; SvC (3) ; PE (3) ; H&R (Civ Pers Off) (1), (Ind Disp (1) ; PG (Civ Pers Off) (1), (Ind Disp) (1) ; Ars (Civ Pers Off) (1), (Ind Disp) (1) ; ASF Dep (Civ Pers Off) (1), (Ind Disp) (1) ; Dep 3, 5, 8-11 (Civ Pers Off) (1), (Ind Disp) (1) ; AG Pub Dep (Civ Pers Off) (1), (Ind Disp) (1) ; QM Mark C (Civ Pers Off) (1), (Ind. Disp) (1) ; Div Eng (Civ Pers Off) (1), (Ind Disp) (1) ; TCRRS (Civ Pers Off) (1), (Ind Disp) (1) ; Repair Shops 2, 9, 10 (Civ Pers Off) (1), (Ind Disp) (1) ; Insp Zones 11 (Civ Pers Off) (1), (Ind Disp) (1) ; Laun- dries 10 (Civ Pers Off) (1), (Ind Disp) (1) ; Ord SvC Shops (Civ Pers Off) (1), (Ind Disp) (1) ; Sub Dep 5, 10 (Civ Pers Off) (1), (Ind Disp) (1) ; Branch Dep 5 (Civ Pers Off) (1), (Ind Disp) (1). Refer to FM 21-6 for explanation of distribution formula CONTENTS Page SECTION I. GENERAL INSTRUCTIONS I II. INDUSTRIAL HYGIENE ENGINEERING SERVICE 3 III. RELATIONSHIP WITH CIVILIAN PERSONNEL DEPARTMENT 5 IV. PREVENTIVE MEDICINE PROGRAM AND JOB ASSIGNMENT 7 V. EMERGENCY MEDICAL OR SURGICAL CARE 15 VI. EMPLOYEES RETURNING FROM SICK LEAVE 18 VII. RECORDS AND REPORTS 20 VIII. INDUSTRIAL DISPENSARY BUILDINGS 25 IX. INDUSTRIAL DISPENSARY SUPPLIES AND EQUIPMENT 27 Standard Industrial Dispensary FOREWORD An industrial medical program has as its mission not only emergency medical and surgical care but also the reduction of absenteeism. To reduce absenteeism, a prospective employee should be properly fitted, mentally and physically, for the job to which he is assigned. A healthy worker employed in a safe and hygienic working environment has an incentive to do his job well. ' This manual is presented as a guide to be followed in establishing and maintaining adequate medical service for employees in Army-owned and Army-operated industrial installations within the Army Service Forces. It is not all-inclusive or limiting. Depending upon the personnel avail- able in the industrial medical department and the type of industry, some of the subjects men- tioned should be stressed to a greater degree than others. The industrial medical officer reading this manual will learn the importance of preventive medicine in industry, and apply it to the em- ployees under his care. A well-run medical department will have a definite effect on decreasing absenteeism, increasing production, and reducing total operating costs. SECTION I GENERAL INSTRUCTIONS I. Basic Directives Circular No. 198, War Department, 1944, as amended by section I, Circular No. 242, War Department, 1944, outlines the industrial med- ical program of the Army. It is the duty of medical officers and civilian physicians assigned to industrial medical dispensaries in Army- owned and Army-operated installations to fa- miliarize themselves with this circular and such other directives as are published from time to time concerning this program. 4. S.O.P. for Industrial Medical Service The shortage of physicians both in the Armed Forces and in civilian life requires that proper organization of the medical department be ef- fected with the responsibilities of nurses and doctors definitely outlined. Small dispensaries and aid stations may be operated by nursing personnel, but such services will always be the responsibility of a medical officer, and there will be at all times available, on call, doctors or medical officers for professional advice and assistance. It will also be the responsibility of the medical officer to provide all nursing per- sonnel with standing orders which will contain explicit directions as to the extent of their ac- tivity in rendering emergency care and med- ical advice. 2. Status of Employees The civilian employees of Army-owned and- operated industrial installations are civil serv- ice employees and come under the provisions and benefits of the United States Civil Service Commission and the United States Employees’ Compensation Commission, which provides compensation for service-connected illness or injury. 5. Industrial Medical Personnel The industrial medical department will be staffed with the minimum of commissioned offi- cer personnel. Wherever possible, civilian phy- sicians, either contract surgeons or those in civil service grades P4, 5, 6 will be employed. Large and important installations will of necessity re- quire a medical officer to be in charge of the medical service. Physician assistants, wherever possible, will be civilians. The number of phy- sicians or medical officers assigned to the Indus- trial Medical Service will vary with the size of the plant population and with the type of in- dustry. An explosive or chemical plant requires more medical personnel than would a storage depot of equal size. It is desirable that the ratio of doctor to employee should not be less than 1:3000. 3. Functions of Industrial Medical Officer The medical officer in charge of the industrial medical program at an Army-operated indus- trial installation has two main functions: (1) the emergency care of sick and injured em- ployees, and (2) preventive medicine. Both are essential. A medical officer may administer an excellent emergency medical service; but unless he knows the employee’s job, the materials with which the employee comes into contact, and the environmental conditions under which he works, he cannot evaluate symptoms arising from oc- cupation, nor will he be able to make recom- mendations for the prevention and control of occupational illness. The industrial medical offi- cer must know his plant and the types of opera- tion going on therein. Recommendations for the improvement of conditions affecting employee health within the plant are the responsibility of the doctor. It is impossible to judge the ability of a prospective employee to carry out the work to which he is to be assigned without sufficient knowledge of what this work entails. Adequate time should be devoted to observation of plant operations and general working conditions. 6. Nursing Personnel Nursing personnel will be registered graduate nurses. Army Nurse Corps personnel will not be assigned to duty in the industrial medical service. The ratio of nurses to employees should be about 1:750 or 1000. 7. Technicians and Clerical Personnel Technicians and clerks will be civil service em- ployees wherever possible. The number of clerks 2 and technicians needed depends entirely on the amount of work required at the installation. physician. 9. Military Personnel Assigned to Industrial Operations 8. Contractor Employees Acute illnesses or injuries of contractor em- ployees will receive emergency care or treat- ment. For subsequent care, these individuals will be referred to their employer’s designated The general precepts of preventive medical ac- tivities outlined for the industrial medical pro gram will be applied to military personnel as signed to industrial operations. SECTION II INDUSTRIAL HYGIENE ENGINEERING SERVICE 10. Value of Engineering Assistance Industrial hygiene is concerned with (1) the quality of air breathed by the workers, (2) the cleanliness of the working place and the opera- tions, and (3) the fitness of the worker for the job. Any of these factors may influence the effi- ciency of the worker and therefore the produc- tion of the industrial plant. Although these factors are concerned primarily with the etiol- ogy of occupational disease or illness, certain aspects of their study and control require ex- perience that is gained in fields of engineering rather than in medical training. For this rea- son, industrial hygiene engineer officers are es- sential aids in the over-all picture of the indus- trial medical program. gineer is the evaluation of all occupational ex- posures. Generally, this evaluation may include collection and analysis of atmospheric samples of contaminants, measurements of ventilation rates, observance of personal habits of em- ployees, study of processes, condition of equip- ment, analysis of materials used, length of ex- posures, and appraisal of plant housekeeping. Other factors which assist in evaluating a haz- ard include reports on incidence of occupational disease, studies of absenteeism and its relation to occupational and nonoccupational illness, ac- cident rates, complaints of employees. In some instances, the experience and knowledge of the engineer will be such that an evaluation can be made without detailed study; in others, special assistance through the facilities described at the conclusion of this section may be sought. I I. Operational Inventory While it is important that the industrial med- ical officer know all operations which involve exposure to toxic materials, the engineer is best fitted to obtain this information. The engineer should make a complete inventory of all proc- esses and include for each operation, the fol- lowing information: name and description of operation, number of persons engaged, mate- rials used, produced and handled, substances potentially hazardous, existing control measures if any, and an opinion as to the efficiency of the control measures. In other words, he should be able to tell the industrial medical officer “what he has in the plant.” This information is useful to the medical officer as an aid in recommending assignment and transfer of employees, diag- nosis and treatment of illness, promotion of health programs. The engineer must keep this inventory accurate. Processes change, new ones are added, and materials and substances used may vary in composition from one lot to an- other. It is essential that the engineer consider this duty as a continuing one—one which is never completed. Only in this way can the in- dustrial medical officer have an up-to-date pic- ture of the potential health hazards at the in- stallation. 13. Control Recommendations When it has been shown that a hazard exists at an operation, the industrial hygiene engineer should prepare recommendations for its control. The method of control of an occupational health hazard may vary, depending on conditions. However, control methods which the engineer will recommend may be grouped under the fol- lowing general classifications: Use of local and general ventilation, use of nontoxic or less toxic materials, segregation and isolation of proc- esses, use of personal protective devices and materials, reduction of length of exposure, wet methods, improved housekeeping and equipment maintenance, development of proper working habits and operating techniques. Sometimes it may be necessary to recommend a combination of several types. Also, while not a function of the engineer, control of a hazard may require medical control measures such as periodic ex- aminations, clinical tests and transfer of work- ers. 14. Importance of Rechecks A comprehensive industrial medical program is not complete unless the engineer makes frequent check studies to determine whether or not his recommendations have been adopted, and to 12. Evaluation of Occupational Exposures Another function of the industrial hygiene en 3 4 measure the effectiveness of the control meas- ures. Such follow-up work is necessary. Essen- tially this phase of the work must be a contin- uing reevaluation of the hazards. One of the most important phases of the follow-up work is the determination of maintenance of equipment, for example, measuring air flow to see if con- trol velocities are not decreased due to such causes as clogged ducts, closed dampers, fan belt slipping. tions of occupational health hazards. In addi- tion, where an industrial hygiene engineer is not available in the next higher echelon or where an evaluation of the occupational ex- posures at a particular installation requires de- tailed studies involving the use of field and laboratory equipment, such studies can be made by the Army Industrial Hygiene Laboratory, upon request through channels to the Office of The Surgeon General. Engineers from the Lab- oratory are available to prepare inventories of processes, evaluate hazards, prepare control rec- ommendations, design plans of engineering control for recommendations made, and deter- mine compliance with and effectiveness of con- trol measures. The Laboratory maintains a chemical analytical section which will analyze and report on compositions of materials sus- pected of containing toxic substances. 15. Availability of Engineering Assistance Since it is impractical to assign an industrial hygiene engineer to each Army industrial in- stallation, where the activities do not justify the full-time services of one, there is an industrial hygiene engineer assigned to the headquarters of the various service commands, whose serv- ices may be requested for periodic investiga- SECTION III RELATIONSHIP WITH CIVILIAN PERSONNEL DEPARTMENT 16. Necessity for Cooperation are comprehensible to the layman. Furthermore, his recommendations should be based, not merely upon an examination of the general health of the appointee, but also upon considera- tions arising from his knowledge of the type of work contemplated and any specific limiting or disqualifying factors which have come to his knowledge as a result of the examination. These considerations should apply in all cases of pre- placement and periodic examinations, in any proposed reassignment of an employee, and in the evaluation of a worker’s physical condition upon the termination of his employment. Cooperation between the industrial medical de- partment and the personnel department of an installation is essential to the efficient function- ing of each. Both share in a common goal: the placement of the employee in the job for which he is best fitted, and the continuing assistance to the employee with whatever support or help is necessary for the best performance of his duties. In the discharge of a third obligation— the handling of cases involving the question of compensation for service-connected illness or injury—the necessity for collaboration between the medical officer and the personnel director is obvious. 19. Common Goal: Correct Job Placement 17. Exchange of Information It cannot be too strongly emphasized that the efforts of both medical officer and personnel director should be directed toward the adjust- ment .of the capacities of the employee to the demands of the job. The utilization of physically handicapped or otherwise limited employees has become such an important aspect of the man- power situation that its accomplishment may be said to be a major test of the efficiency of the placement and industrial medical service. Only those applicants should be barred from work on the basis of a preplacement physical examina- tion whose condition is such that their employ- ment would endanger the health and safety of themselves, their fellow employees, or endanger the plant itself. When a limitation is placed by the medical officer on the nature of an employ- ee’s duties, it should be so indicated that it will be unmistakably clear and definite not only to the employee himself but also to his supervisor, as well as to the personnel department. It thus becomes imperative that the industrial medical officer acquaint himself with the person- nel department of a post, with its functions, its responsibilities toward the employee, and its method of operation. The industrial medical and civilian personnel officers will cooperate in developing methods for referring appointees and employees for replacement, reassignment, and terminal examinations. To facilitate their common objective, the personnel department should furnish the medical officer with adequate information concerning the duties of the job to which it proposes to assign the appointee, or to which it proposes to transfer an old employee, although this obligation does not absolve the medical officer from the responsibility of know- ing and evaluating the occupational health or injury hazards of the assignment. Likewise, as a practical matter, the medical officer’s task will be eased if he has some advance knowledge of the employment plans and estimates of the per- sonnel department, and can schedule his work accordingly. 20. Confidential Medical Data The professional ethics upon which the estab- lishment of patient-physician confidence rests require that during the period of a worker’s employment, medical records, including those of physical examinations and treatments, will be held confidential by the medical department. Observance of this rule will obviate the possi- bility of embarrassing situations arising when technical medical information passes through 18. Recommendations of Industrial Medical Officer The medical officer, in his turn, should assist the personnel director by making suitable recom- mendations concerning the physical fitness of appointees for job assignments, in terms which 5 6 the hands of clerical assistants outside the med- ical department. It will tend to encourage an attitude of mutual confidence and respect be- tween the employees and the medical officer without which the job of the latter becomes im- measurably more difficult. Unquestionably, how- ever, the corollary to this rule is the obligation on the part of the medical officer to make suit- able recommendations regarding the appointee’s assignment referred to in paragraphs 3 and 4. In general, these recommendations, signed by the medical officer, will be sufficient for the em- ployee’s personnel (201) file so long as he is employed at the installation. SECTION IV PREVENTIVE MEDICINE PROGRAM AND JOB ASSIGNMENT 21. Preplacement Examination But the physical capabilities of female workers require careful attention to proper job place- ment. Women are on the average shorter, lighter, and less strong than men, for whom most machines have been designed. Problems of seating, reaching, leverage, size of handles, etc., need due consideration and the solution may require alterations in guards and tools if fatigue, and as a result, illness and employee turn-over are to be kept at a minimum. Many employed women have a dual responsibility, that of home duties in addition to their work in the plant, and this fact, plus pregnancy, dys- menorrhea, and the menopause, requires careful placement and regulation of hours of employ- ment if absenteeism rates are tq be controlled. Many of these factors may be overlooked by a medical officer who restricts his functions to treating an ill or injured employee. All prospective employees will be given a pre- placement examination by the industrial med- ical officer or a member of his medical staff where an established medical service is in op- eration. The physical examination of the male applicant will be done on a stripped subject, and will include complete inspection. In the case of a female applicant, this examination will be in the presence of a nurse or other female mem- ber of the medical staff. Females should be pro- vided with a private compartment in which to strip to the waist and put on a chest cape. 22. Other Preventive Medicine Considerations The nature of the duties of the employee will be given careful consideration, and where desir- able in the judgment of the medical officer, ad- ditional clinical or laboratory procedures will be accomplished. A thorough physical appraisal is essential in order to place an individual suit- ably and in keeping with his physical status. Returned soldiers who have suffered physical impairment in the military service and other applicants with physical limitations will receive special consideration, and must be placed in suitable employment as determined by civil service regulations. These individuals will re- quire special periodic rechecks for their pro- tection and to determine the continued suitabil- ity of their work. It is important also that fe- male employees receive special consideration with respect to the nature and type of work to be performed. No effort will be spared by the members of the medical department in making recommendations to protect and maintain the health and well-being of the employees. 24. Special Cases The handicapped worker and the soldier return- ing from active service present a problem which requires much careful thought and knowledge of the plant and its operation if such individuals are to be adjusted properly to industrial activi- ties. It is necessary that cooperation with civil- ian personnel officers and their assistants be maintained at a high level in attempting to dis- cover possible mental cases among those being rehired. 25. General Criteria It is not the desire or the intent of this manual to set physical standards, since all applicants will of necessity require individual case ap- praisal. From a knowledge of the duties to be performed in the proposed work, and the phys- ical appraisal of individuals and their existing defects, judgment will be exercised by the ex- aminer in approval for employment and rec- ommendations for job placement. 23. Female Employees Where female workers predominate, a program of general preventive medicine is essential. Other conditions being equal, female employees can be utilized as efficiently and safely as men. They may be employed at any “toxic” opera- tions that have been made safe for men, as there is no satisfactory evidence that they are more susceptible to chemical intoxication than men. Physical Examination Record (WD AGO Form 8-179) (see figs. 1 and 2) will be used by all industrial medical departments to record pre- 26. Physical Examination Record 7 8 placement and periodic examinations. It will be completed by the examining medical officer or physician for all employment or reemploy- ment applicants previous to job assignment, and will form a permanent part of the employee’s medical 201 file. Information contained on this form will be held confidential by the industrial medical department during the period of the name of installation Bluestone Ordnance Depot Figure 1. WD AGO Form 8-179, Physical Examination Record. (Front.) PHYSICAL EXAMI NAT I OH RECORD 9 individual’s active employment. The following general rules for completing the form will apply: a. In general, the results of the examination will be recorded by checking the box “YES” or “NO” opposite the listed items. If a particular part of the examination is not done, “NX” will be written in the “YES” column. Thus a check 97. other abnormalities A. Hospitalized 1938-right hernioplaaty, uneventful recovery, B. Classified a5 occupational -rafgActYdn. Slight hearing defeat. Pynrrhea r , dental carles. Mitral valvular disease.Tenderness eT icltJ§&Lin..rlght flank. History obtained indicated possibly a low grade kidney infection .3. moe. prior to examination on questioning denied any present symptoms. 98. immunization: small pox 10/17/43 revaccination oTHERsjypkoid & para-typhoid inoculation 1941 99. diagnosis and comments (1) Psoriasis. general!zed. (2) Visual acuity defect-adv. check refraction with fit- tine cf correction. (3) Slight hearing defect, not significant, in view of duties. (4) Pyorrhea alveolarls grads II. moderate dental carles-adv. dental care and treatment. (5) Mitral valvular disease compensated. In view of kidney history and findings urinary findings to be scrutinized. ioi. subsequent examinations 11/17/43* He-check, Skin lesion, i.e,, psoriasis subsiding. Corrected visual acuity now 20/20 Ou, Hearing acuity findings consistent with original findings as recorded. Employee shows clinical evidence of gingival treatment and repair of the teeth, CarcLiac status unaltered, B.P, 140/90, Physical status consistent with the performance of present duties, J.E.D., Capt,, M.C, 10/17/44: No complaints, no recent illnesses. Appearance: Not remarkable,, Skin: No evidence of lesions of psoriasis. T: 98,6°' H, 74 regular, equal, good quality, B.P, 136/86. E.N.T, essentially negative. No progression of hearing changes. Teeth; In good repair. Neck: No adenopathy. Chest: Clear throughout. Heart: Mitral systolic murmur (compensated). Abdomen: Negative findings. Hernia: Hit impaired scar, Bings: Tight. Extremities: Normal. Physical condition; Satisfactory, J.E.D., Capt,, M.C, Figure 2. WD AGO Form 8-179, Physical Examination Record. (Reverse side.) loo, classification and action Approved for duties as designated. Suitable for moderate work. No heavy lifting. 10 entry or “NX” will appear in one or the other of every pair of “YES”—“NO” blocks. This means of recording physical findings is adopted for two reasons: (1) because it requires less writing on the part of the examiner and (2) because recording physical findings by number permits, where available, mechanical tabulation of the type of physical handicaps most common and thus a more workable means of cross-index- ing with ready reference in deciding which em- ployees require more careful periodic checks of physical condition. assignment recommendation with limitations of such assignment if any. Item 101 is to be used for periodic examination findings and not for recording treatments of a minor nature which do not affect the general physical condition of the employee. WD AGO Form 8-173 (Treat- ment Record) (see par. 39), will be used as the primary active means of recording treatments given to employees. The full signature of the examiner is required in ink following the ex- amination when the entire form is filled out. Initials will suffice for subsequent examinations if legible and if reference to the examiner is sufficiently clear by initials. b. At the bottom of each system block — “Appearance,” “Eyes,” “Ears,” etc.—there is a line or two—Item 19 for “Appearance,” Item 34 for “Eyes,” Item 43 for “Ears,”—in which may be made a short statement describing a particular phase of the examination not covered by the listed items of the particular system block, or an expansion of information recorded by the “YES”—“NO” check system. See the model “Physical Examination Record,” for ref- erence. 27. Immunizations At the time of their preplacement examination, applicants should be vaccinated against small- pox unless they can prove a successful vaccina- tion within 5 years. Every effort should be made to persuade reluctant individuals of the value of vaccination. Experience has shown that most persons will accept vaccination. A very small number will refuse. c. The first 6 items are self-explanatory. It is essential to check whether the examination is preplacement or reemployment, Item 7. Under Item 12, “Pulse,” character should be recorded as normal or irregular in rhythm, and whether due to premature beats of the heart with drop beats at the wrist (this may be indicated by “P.B.”) or due to auricular fibrillation, etc. Under Item 14, a short statement of the pro- posed duties of the job will be recorded. This is done in order that the examiner, by knowing what is expected of the applicant, may give a more exact appraisal of the individual’s fitness for such work. As explained in Item 15, when a person has been hospitalized or has received compensation for occupational injury or illness, a statement concerning such information will be made under Item 97, “Abnormalities.” Under Item 21 and others similar, the “R”, “L” per- tain to right and left. Under Item 78, “EXT” pertains to external and “INT” to internal hemorrhoids. Under Item 91, directly following “Veins Normal,” mention and description of varicose veins should be made if present. Under Item 97 an opportunity is given the examiner to record “Other Abnormalities” not covered in the questions answered on the front sheet. Item 99 should contain a diagnosis and a notation of any medical or general suggestion given the applicant for correction or control of physical defects. Item 100 should contain a notation of a.. The occasional individual who, on religious or other grounds, refuses to be vaccinated should not be barred from employment, unless there is an actual or threatened epidemic of smallpox in the vicinity. b. Paragraph 9e, AR 40-210, provides the commanding officer of a Government reserva- tion with authority to exclude from the reserva- tion, unvaccinated persons if, in his opinion, such action is essential to protect the popula- tion against an impending outbreak of small- pox. c. A general immunization program for em- ployees against other diseases such as typhoid or tetanus is warranted only when there is a specific indication for it. d. A suitable entry of each immunization will be made on the Physical Examination Record form. 28. Serologic Tests for Syphilis The employment of individuals with respect to venereal disease will be governed by the follow- ing: a. Where practical, all new employees will be given an acceptable blood serologic test for syphilis. b. All individuals whose work will entail ex- posure to chemicals or toxic substances which may affect the liver, will receive a serologic test for syphilis. 14" by 17" films. At the conclusion of the survey, the medical officer of the installation will be in- formed concerning positive and suspicious cases. Cases of communicable pulmonary tuber- culosis will be relieved from active duty both for their own protection and that of other em- ployees. They will be referred to their own pri- vate physician or the local county or state pub- lic health authorities. Questionable cases of pulmonary tuberculosis will be rechecked fol- lowing a sufficient time interval by the indus- trial medical officer with such aid as may be required from public health authorities, and contact with the employee’s family physician should be made informing him of the status of the particular individual. c. It has been clearly established that the usual serologic tests for syphilis may be tem- porarily positive as a result of causes other than syphilis, such as vaccination for smallpox and certain febrile diseases. Therefore, those indi- viduals on whom a positive serology is reported, from an acceptable laboratory, should have a repeat serology performed after an interval of 7 to 10 days. Should the second report also be positive, the individual should be referred to his private physician, or a suitable clinic, as is his desire. All information on such a subject will be held in strictest confidence by the medical department. d. Job placement of individuals with con- sistently positive serologic tests for syphilis: (1) Those individuals presenting open in- fectious lesions will not be employed until after at least two intravenous treatments with a suit- able arsenical which will prevent communica- bility if regular treatment is given thereafter. 3S. Special Examinations Periodic examinations including appropriate laboratory tests will be given to those employees exposed to toxic chemicals or procedures. The frequency of these examinations will depend upon the judgment of the medical officer unless otherwise directed. Clinical notations of these examinations will be recorded under Item 101, “Subsequent Examinations,” of the Physical Examination Record. (2) Employment of such individuals, includ- ing those with open lesions, will be predicated upon their receiving continued, adequate anti- syphilitic treatment. Reports of the physicians or clinics concerning these treatments will be required on a monthly basis. All such reports will be held in strictest confidence by the med- ical department. 32. Annual and Terminal Examinations Where the size of the medical staff permits, an- nual and terminal examinations will be made of all employees. This procedure is of vital im- portance in maintaining employee health, de- creasing absenteeism, and obviating future compensation claims. These examinations will be recorded under Item 101, “Subsequent Ex- aminations,” of the Physical Examination Rec- ord. (3) No such individual will be recommended for work involving exposure to chemicals or toxic substances which may affect the liver. 29. Chest X-Rays Where practical, an X-ray of the chest will be made on new applicants especially those as- signed to work involving contact with dusts, fumes, or toxic gases. Cases with active pul- monary tuberculosis will not be employed. 33. Classification of Employees Based on Medical Evaluation 30. Mass Tuberculosis Surveys The industrial medical department in classify- ing an applicant for job placement on the basis of physical examination, should be supplied with sufficient information from the personnel de- partment as to what the proposed job is accord- ing to a job work sheet. Thorough knowldege by the examiner of the various plant operations will also be of assistance in permitting proper evaluation of the applicant’s fitness for the job. In the case of physically handicapped appli- cants, a familiarity with the “Operations Man- ual for Placement of the Physically Handi- Through cooperation with the Tuberculosis Con- trol Division, United States Public Health Serv- ice, mass chest X-ray surveys of the entire em- ployee population of any Army-operated indus- trial installation are available; request should be made through channels to The Surgeon Gen- eral. These chest X-ray surveys are conducted by officers of the U. S. Public Health Service, using their own equipment, on 35-mm films. Questionable cases are checked with standard 12 capped” (United States Civil Service Commis- sion, Washington, D. C., 3d Edition, June 1944) will facilitate the apprehension of physical lim- itations and suggest categories for correct job placement. as confidential medical information will be in- cluded in the “Physical Qualification Placement Record.” Recommendations for job placement other than that originally proposed should be entered in this section, which should also carry the signature of the medical officer or industrial physician recommending the classification. 34. Physical Qualification Placement Record It is essential that an adequate classification of prospective employees be made and sufficient information given to other departments by which they may appropriately place a worker. In order to fulfill this responsibility WD Form No. 91 Physical Qualification Placement Rec- ord (see fig. 3), submitted by the Civilian Personnel Office will be completed and returned to the Personnel Department, and other depart- ments of the installation requesting it, and hav- ing a legitimate interest therein. One copy will be retained and incorporated in the applicant’s medical 201 file. /. Section ten, “Disability Classification Code Number.” Classification of applicants pos- sessing one or more of the disabilities listed below will be indicated by entering the applica- ble code number, or numbers, in this section. This information is given to the Civilian Per- sonnel Department for the purpose of consoli- dating placement records on handicapped indi- viduals; such data will be used by the United States Civil Service Commission, which is re- quired by law to keep statistical records on the placement of handicapped employees and which is attempting “to standardize minimum physical requirements necessary for various positions in the Federal Civil service.” a. Section five of this record will have checked either one of the three classifications referable to a person’s physical fitness for ardu- ous, moderate, or light work. This classifica- tion depends upon an applicant’s ability for physical exercises and work. (The following table is taken from figure 3, p. xii, “Operations Manual for Placement of the Physically Handicapped,” 3d Edition, June 1944, U. S. Civil Service Commission, Washing- ton, D. C.) : b. Section six of this record will have checked any of the twenty-one limitations to be observed in job assignment of the applicant. These limitations may not coincide with those indicated in the classifications in section five. For example, a person may be fit for “ar- duous work” and still should not be assigned to a job requiring accurate near vision, in which case block No. 10, section six will be checked. This same applicant may have others of these blocks checked, as for example No. 13, “Ex- posure to dampness or chilling.” Disability Classifications with Code Numbers1 1. Orthopedic: Code Number (a) Amputation of— Arm* 01 Arms ! 02 Hand* 03 Hands 04 Fingers8 05 Leg4 06 Legs 07 Foot3 08 Feet 09 (b) Disability or deformity of— Hip or shoulder 12 Arm2 13 Arms 14 Hand2 15 Hands 16 Fingers5 17 Leg3 18 Legs 19 Foot2 20 Feet 22 Back 24 Hips or shoulders 26 c. Section seven of this record refers par- ticularly to the need for the wearing of correc- tive medical appliances while on the job. d. Section eight is specifically worded for the following reasons: An applicant for em- ployment may have physical disqualifications which could improve to the extent that on sub- sequent examination he would not necessarily be disqualified. It is unwise to state that a per- son on the basis of one physical examination will be permanently disqualified from work. e. Section nine, “Remarks.”’ Under this section any comments concerning the person’s physical condition which it is felt should be known by other departments will be listed. No comments or remarks which could be construed 13 Code Number Code Number 2. Vision defects: Blind 28 Blind in one eye with good vision in the other 30 3. Hearing defects: Deaf 31 Hard of hearing7 33 4. Chronic diseases: Cardiac8 37 Tuberculosis (pulmonary)9 44 5. Miscellaneous: Dwarf 39 PHYSICAL QUALIFICATION PLACEMENT RECORD 1. DATE Oot. 17, 1944 2. NAME 3. BADGE NO. 6840 Smith, Frank A. POSITION TITLE, SPECIAL WORKING CONDITIONS AND/OR PHYSICAL REQUIREMENTS (Specify numbers of the blocks shown In 6 below applicable to this position) Lathe Operator (Metals) 3,5,7,10,12,20 TO BE COMPLETED BY EXAMINING PHYSICIAN R. THIS PFRSON IS QUALIFIED FOR THE FOLLOWING TYPE OF WORK: ARDUOUS WORK J MODERATE work (Excluding severe nmual labor) JLIGHT WORK (Sedentary, or non-laborious type of work, 6. LIMITATIONS: NOT TO BE ASSIGNED TO A JOB REQUIRING: 1. ANYTHING OTHER THAN BENCH WORK X 2. HEAVY LIFTING 3. ANY LIFTING 1. REPEATED BENDING 5. CONTINUOUS WALKING OR STANDING 6. WORK ON LADDERS OR OVERHEAD 7. EXPOSURE TO DUSTS _ 8. EXPOSURE TO CHEMICAL FUMES 9. ACCURATE FAR VISION _ 10. ACCURATE NEAR VISION 11. GOOD HEARING _ 12. WORK AROUND MOVING MACHINERY _ 13. EXPOSURE TO DAMPNESS OR CHILLING IN-. TRUE COLOR PERCEPTION (color blindness) 15. CRANE-TRUCK OPERATION _ 16. TUG TRUCK,TRACTOR OR MOTOR VEHICLE OPERATION _ 17. OPERATING FEEDING MACHINERY _ 18. WORK AROUND TRAFFIC 19. EXPOSURE TO SOLVENTS OR GREASES 20. EXPOSURE TO EYE HAZARDS 21. ?. THIS PERSON IS QUALIFIED FOR WORK ONLY AFT|R; x] a. PROCURING PROPERLY FITTED EYEGLASSES _X b. PROCURING PROPERLY FITTED SAFETY GOGGLES _ c. PROCURING PROPERLY FITTED TRUSS _J d* OTHER IT IS RECOMMENDED THAT THIS PERSON NOT BE EMPLOYED ON THE BASIS OF PHYSICIAL EXAMIN- ATION THIS DATE. 9. remarks; 10. DISABILITY CUSS! FI CATION CODE NUMBER: SIGNATURE OF EXAMINING PHYSICIAN To be completed by Supervisor and returned to Civilian Personnel Officer 11. NAME „ . . Smith, Frank A. 12. BADGE NO. 5840 13. SHIFT 8-4 11. ORGANIZATION LOCATION OF POSITION Machine Shop, Section No. 1 15. POSITION TO WHICH ASSIGNED AND BRIEF DESCRIPTION OF DUTIES Lath© Operator (Metals). Stands at -work. No heavy lifting. No exposure to solvents or greases. Properly fitted eyeglasses and safety goggles have been obtained. WO FORM 91 APPVD. 32!march SIGNATURE OF SUPERVISOR DATE Oct. 20 »44 Figure 3. Physical Qualification Placement Record. 14 ‘A combination of disability code numbers listed for any particular position not necessarily to be interpreted to indicate that a combination of all the defects would be acceptable for placement in that position. 2With other member intact and fully functioning. “One or more fingers missing on secondary hand with good residual grasping power in that hand and normal function of primary hand. In some positions good grasp- ing power not required in secondary hand. ‘Amputation one lower extremity with satisfactory nrosthesis and with other lower extremity intact and fully functioning. “One or more fingers disabled on secondary hand with good residual grasping power in that hand and normal function of primary hand. In some positions grasping power not required in secondary hand. “Sense of hearing nonfunctioning for ordinary pur- poses of life. Code number may include deaf mutes, de- pending upon amount of communication required in routine performance of duties of position in question. TSense of hearing although defective, functional with or without hearing aid. 'Organic heart disease, other than coronary disease, fully compensated without history of decompensation. “Tuberculosis healed or arrested according to classi- fication of National Tuberculosis Association. For some positions of sedentary type and in suitable working environment, persons receiving collapse therapy may be considered. g. The lower detachable third of the record will be completed by the supervisor and re- turned to the industrial medical department through the Civilian Personnel office. This ac- tion enables the industrial medical officer or physician to check to see that the employee actually is assigned to work for which he or she is physically qualified. This card will be referred to in periodic and special examinations of the employee and included in his medical 201 file. SECTION V EMERGENCY MEDICAL OR SURGICAL CARE tion of private physicians or for designated phy- sicians in localities where Government hospitals and dispensaries are available” (Civilian Per- sonnel Regulations No. 90.5-5, War Depart- ment, 3 Sep 1943). “If there should be no United States medical officer or hospital or des- ignated physician available, such services shall be furnished by a duly qualified physician. Au- thorization for prolonged treatment from such a physician should be obtained from the com- mission” (sec. 2.1. (a), U.S. Employees’ Com- pensation Commission Regulations, Washing- ton, 1939). If hospitalization is required, the rules set forth by the U. S. Employees’ Com- pensation Commission in its regulations and by AR 40—590, par, 65(10) and (19), will be fol- lowed. Cases may be referred to specialists for diagnosis and/or treatment when in the opinion of the industrial medical officer or the desig- nated physician the condition may best be treated by a specialist. Authorization for treat- ment by a nondesignated physician or a non- governmental facility should be in letter form, and any action taken in this regard should be communicated to the Commission promptly. b. If the industrial medical department is adequate from a personnel and physical equip- ment standpoint to render necessary treatment and the employee may receive ambulatory treat- ment, this treatment will be afforded the em- ployee throughout the course of his injury or illness. 35. Priority of Emergency Treatments The first and main function of an industrial medical program is to provide adequate emer- gency care for sick or injured employees. The proper handling of acute illnesses or injuries will take precedence over the routine work of the department. To this end, adequate medical service will be available to civilian employees during all working shifts. If the total number of employees on any shift does not war- rant the presence of a physician in the indus- trial medical department, arrangements will be made to have a physician on call near enough to be able to handle emergency situations. 36. Occupalional and Nonoccupational Injury or Illness Defined There are two classifications of conditions under the type of medical service here contemplated: a. Occupational injury or illness, comprising any injury resulting from accident, damaging, or harming the physical structure of the body and arising out of and in the course of employ- ment; or any disease or illness resulting from continuous or intermittent exposure of the em- ployee to his occupational environment, and arising out of and in the course of employment. b. Nonoccupational injury or illness, com- prising all cases not covered in a above. 37. Necessary Treatment for Occupational Injury and Illness When an employee presents himself for med- ical aid for occupational illness or injury, it is the responsibility of the medical department to see that he receives that care and treatment necessary under the circumstances. ci. Cases which cannot be handled by the in- dustrial me acal department or which require treatment a way from the installation will be re- ferred to one of the designated private physi- cians listed in United States Employees’ Com- pensation Commission Form C.A. 76 (Medical Facilities), copies of which are obtainable from the commission. “Mere convenience or personal preference of the injured employee will not be considered sufficient explanation for the selec- 38. Treatment for Nonoccupational Injury and Illness If an employee consults the medical department for nonoccupational injury or illness during working hours, emergency treatment will be given to conserve work-time. Symptomatic treatment will frequently enable an employee to return to work. Nonoccupational illness or ■injury requiring continuing medical care will be referred to the employee’s family physician, who will be afforded such information as is available in the medical department concerning the employee. It is not the aim or scope of the Army Industrial Medical Program to interfere 15 16 with that medical service which should be rendered by civilian physicians of the commu- nity. date on which the injury occurred must be entered as well as the date of treatment. The same card will be used for subsequent treat- ments given the same employee, and will form a permanent part of his medical 201 file. 39. Treatment Record Whenever a civilian employee receives medical or surgical treatment from the industrial med- ical department, for either occupational or non- occupational injury or illness, a notation to this effect will be made on WD AGO Form 8-173 (Treatment Record). (See fig. 4.) This entry will show the employee’s name, his badge num- ber, the plant location where he works, the date of his treatment, a brief description of his symptoms or a diagnosis of his case, a notation 40. Completion of U.S.E.C.C. Forms In cases of occupational injury or illness, United States Employees’ Compensation Commission Form CA-1 (Employee’s Notice of Injury), Form CA-2 (Official Superior’s Report of In- jury) and Form CA-20 (Medical Report) will be completed as prescribed and forwarded to the U. S. Employees’ Compensation Commis- sion, through the Civilian Personnel Office, in any of the following conditions (see g below) : TREATMENT RECORD Figure 4- WD AGO Form 8-173, Treatment Record. of any treatment given, the disposition of the case (sent home, back to work, or to some other medical facility for further examination or treatment), and the initials of the nurse or phy- sician who actually treated the employee. In addition, a check will be entered in one of the “Performance of Duty” columns indicating whether or not the injury or illness arose out of and in the course of employment; and if the injury or illness is occupational in origin, the a. When the injury causes loss of time from work beyond the day, shift or turn on which the injury occurred. b. When any medical expense is incurred other than for dispensary outpatient treatment, or when the employee is referred to any other medical facility for treatment. c. When any permanent disability, either ana- tomical or functional, may result from the in- jury. 17 d. When there may be a probability of future infection or disability. e. When the period of outpatient treatment extends more than ten days. /. When the employee indicates any desire or intention to file a claim with the Commission. g. For instructions on the completion and submission of U. S. Employees’ Compensation Commission forms, see War Department Civil- ian Personnel Procedures Manual 121, “Report- ing Employee Injuries and Death Occurring in Performance of Duty,” which contains illustra- tions of completed forms and procedural rules. This manual is available at all adjutant general distribution depots (Cir. 264, WD, 28 June 1944) and air service command depots. U.S.E.C.C. forms may be requisitioned direct from the United States Employees’ Compensa- tion Commission, 285 Madison Ave., New York 17, N. Y. 41. Required Poster United States Employees’ Compensation Com- mission Form CA-10 (What to Do in Case of Injury) will be posted in a conspicuous place in each industrial dispensary or aid station. SECTION VI EMPLOYEES RETURNING FROM SICK LEAVE 42. Clearance Through Medical Department Employees becoming ill or injured on the job who must be sent home will report to the med- ical department prior to leaving the installa- tion. When these employees return to work they will report to the medical department for eval- uation of their physical condition prior to re- suming their job assignment. Should the ex- amination of such individuals at this time re- veal information which makes it advisable that they be classified in other than their previous classification, this information will be submitted 43. Medical Absentee Record All absence attributable to illness or injury will be recorded on the Medical Absentee Record card (WD AGO Form 8-172). (See fig. 5.) In addition to the entries identifying the em- ployee, notations will be made as follows: a. When the employee reports to the indus- trial dispensary prior to leaving the installation on sick leave, there will be entered— (1) The date off work. (2) The “Performance of Duty” status,— whether the disability is occupational or non- WD AGO FORM 8-172 1 MAR 1945 MEDICAL ABSENTEE RECORD Figure 5. WD AGO Form 8-172, Medical Absentee Record. to the personnel department of the installation and the first-line supervisor with recommenda- tion as to limitations of their employment. This type of information will be transmitted by means of the “Physical Qualification Placement Record” (WD Form No. 91). occupational in origin (see definition of these terms in par. 36, sec. V, “Emergency Medical or Surgical Care,,)> If doubt exists on this point, the question will be referred to the in- dustrial medical officer or physician in charge. (3) A brief description of the illness or in- 18 19 jury with a statement of its cause. b. When the employee reports to the indus- trial dispensary upon return from sick leave, there will be entered— (1) The date returned to work. (2) The number of work days lost owing to disability. This number will be computed on the basis of actual calendar days, without regard to leave computed for pay roll purposes. (3) Any diagnosis from medical sources other than those on the installation. c. When an employee becomes ill or is in- jured away from the installation, and following sick leave, reports to the dispensary, all items will then be filled in. d. The Medical Absentee Record is kept for the purpose of recording absence rather than treatments. All medical and surgical treatments, whether connected with absence or not, will be recorded on the Treatment Record card (WD AGO Form 8-173). 44. Computation of Lost Time For the purpose of computing over-all time lost due to occupational illness or to nonoccupational injury or illness, it is recommended that the en- tries of “Days Lost” on the individual Medical Absentee Records be tallied on a work sheet at such intervals—daily, weekly, or monthly—as seem feasible to the industrial medical officer in view of the number of entries to be so tallied (number of employees and frequency of ab- sences), The entries on this work sheet, which will then form the basis of the data appearing in the Quarterly Occupational Health Report (see par. 49), will necessarily show only ac- cumulated days of absence reported for all cases completed on or prior to the date of the tally entry. Days lost by incompleted cases will not be included. Questions of computing time lost due to asserted injury or illness just prior to separation from service or transfer, when the employee does not return to the installation for clearance through the industrial medical de- partment, will be determined in the light of in- formation available to the industrial medical officer and of the decisions of the personnel de- partment. SECTION VII RECORDS AND REPORTS 45. Purpose of Maintenance Adequate medical records will be maintained within the industrial medical department for the purpose of providing necessary information regarding the health of the civilian employees of the installation as well as revealing the scope and emphasis of the department’s activi- ties in relation to the particular occupational environment. Sufficient data will be transmitted to higher echelons to permit an accurate evalua- tion of the operational efficiency of the reporting department and the adequacy of assigned per- sonnel, and to estimate over-all costs. 46. Medical 201 File The industrial medical department will main- tain a personal medical record (or medical 201) file for every civilian employee at the installa- tion of which it is a part during the course of that employee’s active employment. During this period medical officers, contract surgeons, and civilian physicians will at all times remember that physical examinations are privileged com- munications. Knowledge of this fact by an ap- plicant or employee promotes a better relation- ship between the industrial medical department and the plant population, and the requirement should be published. The manner in which in- formation of this type will be divulged to other agencies of the War Department or the federal government will be determined by directives issued as necessary. a. This personal medical record will contain as a basic minimum for each employee the fol- lowing items, which will be considered an inte- gral and inseparable part of it: (1) The employee’s Physical Examination Record (WD AGO Form 8-179) together with records of subsequent examinations. (2) A copy of the Physical Qualification Placement Record (WD Form 91) submitted re- garding the employee, and the indorsement re- turned by his supervisor. (3) Records of laboratory and/or X-ray find- ings. (For available medical forms on which to record these findings, see War Department Pamphlet No. 12-3, List of Forms Stocked by Adjutant General Depots.) (4) Any correspondence relative to the phys- ical condition or medical history of the em- ployed. b. The medical Treatment Record card or cards, and the Medical Absentee Record card or cards, though they need not be kept in em- ployee’s medical record file, will form a perma- nent part of this record, and will be available at all times for review by the industrial med- ical officer or physician. 47. Disposition a. When an employee at an installation op- erating under the Army Industrial Medical Pro- gram is separated from the War Department, his medical file will be incorporated in the per- sonnel (201) file and deposited with the Dis- continued Projects Branch, 911 Douglas Street, Omaha 8, Nebraska. If an employee moves from one such installation to another within the con- tinental limits of the United States, his medical file will be transmitted to his new station; if he is transferred to a new station outside the United States, his medical file will be deposited with the Discontinued Projects Branch as above. b. To effectuate this policy, all medical offi- cers at installations operating under the Army Industrial Medical Program are directed to de- liver the medical files of employees who sep- arate or transfer from the installation, to the civilian personnel officer for transmittal with the personnel (201) file. Documents in the med ical file which within the discretion of the med- ical officer are prejudicial to the best interests of the employee will be classified, and transmit- tal will be in accordance with appropriate Army Regulations governing security of classified in- formation. 48. Compiled Daily and Monthly Tally Sheet a. WD AGO Form No. 8-175 (Compiled Daily and Monthly Tally Sheet) (see fig. 6) is designed to present a survey of the activities of the industrial dispensary or aid station. It will be compiled daily throughout each month by the clerical section of the industrial medical 20 21 COMPILED DAILY AND MONTHLY TALLY SHEET FORM INSTALLATION Bluestone Ordnance Depot station Consolidated Report covering Industrial Dispensary, Aid Sta, A, Aid Sta. B. and Aid Sta. C. shift pir8t Second Third MONTH October PHYSICAL EXAMINATIONS TREATMENTS LABORATORY TESTS MISCELLANEOUS NUMBER RESULT OCCUPATIONAL NON-OCCU- PATIONAL SEROLOGY TO s M © 0) O Eh 3 cr oj 0 08 ( 302 477 608 614 TIqAi&H I NAME QF*INDIVIDUAL COMPLETING FORM WD A60 FORM 8-175 1 mar 1945 28-8677-50 Figure 6. Compiled Daily and Monthly Tally Sheet. 22 QUARTERLY OCCUPATIONAL HEALTH REPORT FOR QUARTER ENDING CONTROL APPROVAL SYMBOL 31 December 1944 MDO 1-115 l, TO: OFFICE OF THE SURGED* GENERAL, OCCUPATIONAL HEALTH DIVISION, WASHINGTON 25, D.C. (Thru: Channe 1 s) 2. NAME AND ADDRESS OF INSTALLATION MAKING REPORT Bluestone Ordnance Depot, Bluestone, Tennessee 3. CIVILIAN PERSONNEL EMPLOYED AT END OF QUARTER 4. MAJOR HAZARDS (Darint Report Period) Ordnance manufacture & maintenance: Exposure to fumes and dust of tetryl, TNT, DNT, lead & other compounds; silica dust; ether & paint vapors; carbon monoxide. Mechanical parts and machinery. MALE FEMALE TOTAL 6007 3514 9521 5. PERSONNEL ADMINISTERING PROGRAM a. MEDICAL OFFICERS OR PHYSICIANS b. NURSES c. TECHNICIANS, CLERKS, ETC. d. TOTAL PERSONNEL FULL TIME PART TIME SHIFTS 3 1 1 2 2 2 : 0 12 n 4. 3 . _ 15 0 7 7 i . .. 30 i 14 13 4 6. UNIT EQUIPMENT AT END OF QUARTER a. INDUSTRIAL DISPENSARIES b. INDUSTRIAL DISPENSARY AID STATIONS c. AMBULANCES NO. OF UNITS NO. OF BEOS 1 5 3 3 3 7. INDUSTRIAL AND NONINDUSTRIAL ILLNESS AND INJURY DATA BY MONTH a. OCCUPATIONAL NO. CASES NO. TREATMENTS NO. DAYS LOST MO. Oct. MO. Nov, MO. Dec. MO. Oct. MO. Nov. MO. Dec. MO. Oct. MO. Nov. MO. vec,„ . 1. ILLNESS 8 8 6 12 14 10 v 0 , 0 ,0 , 2. .INJURY 1307 1346 1285 2650 2701 2593 X X pk b. N0N-0CCUPAT10NAL ILLNESS A INJURY 1644 1628 1809 4720 4662 5022 7064 6256 8347 8. PREVENTIVE MEDICAL ACTIVITIES a. PREPLACEMENT EXAMINATIONS b. PERIODIC EXAMINATIONS C. HANDICAPS CLASSIFIED d. REJECTIONS NO. e. SEROLOGICAL TEST f. X-RAYS OF CHEST g. CONSULTATIONS h. IMMUNIZATIONS NO. 1809 1867. 311 1924 X77 1402 35 1859 9. remarks Major cause for rejection of applicants: uncompensated valvular disease of heart, active tuberculosis. During quarter, 532 annual examinations and 1901 lab, tests for special placement were made. Occupational illness chiefly dermatitis. Mild upper respiratory epidemic occurred in December, Programs in effect include: education in industrial hazards and safety training; nutrition; weekly VD and ortho- pedic clinics, 200-bed station hospital is located on post, 125-bed hospital in Bluestone, Term, miles distant. DATE 2 January 1945 MEDICAL<7oFFICER, CONTRACT SURGEON OR PHYS1C1 AN IN CHARGE OF 1NOUSTR1AL MEDICAL SERVICE JOHN S, DOHN, Captain, Medical Corps, WD AGO FORM 6-177 1 MAR 1945 (SBg ggvESSE SIDE FOB INSTRUCTIONS ) Figure 7. WD AGO Form 8-177, Quarterly Occupational Health Report. 23 department. It may be compiled at outlying aid stations; and by the charge nurse of each work shift if the installation is operating on more than one shift. In these events, the sheets so compiled will be consolidated at the main dis- pensary. The method for tabulating data from which the tally sheet is compiled will be deter- mined locally by the medical officer or physi- cian in charge of the industrial medical de- partment. b. The items on the Compiled Daily and Monthly Tally Sheet are generally self-explana- tory. The month covered will be entered under “Month” in Column 1. Under their respective categories, enter on the horizontal line to the right of the day of the month the number of INSTRUCTIONS General All Army Service Forces installations with- in the scope of WD Circular No. 198 will prsnare the QUARTERLY OCCUPATIONAL HEALTH REPORT (W.D., AGO. Form No. 8-I77) for submission in duplicate through channels within ten days following the close of the quarter period covered (viz., Jan-Mar, Apr- June, July-Sept, Oct-Dec.) The commanding general of the service command in which the installation is located (or in the case of a port of embarkation, the Chief of Trans- portation) will retain one copy and will forward the other copy to The Surgeon General. No letter of transmittal will accompany the report. Items in this form will be completed by the Industrial medical officer or physician at the reporting installation. All medical data will be based on records kept by the industrial medical department at the in- stallation. The form will be completed in its entirety; a negative report for an item will be in- dicated by "0" or "Hone". Items 1-3 Self-explanatory. Item U Indicate principal industrial activities and specify any inherent occupational haz- ard which the industrial medical program is designed to control; , noxious fumes, mists, or gases, dust, explosives, lubricants, solvents, radium, etc.; other mechanical or operational hazards. A positive statement is desired. Item 5 Indicate number of personnel at time of making report. Include contract surgeons under "a. Medical Officers or Physicians." If there is more than one work shift, enter number of department personnel on each shift. ■Item 6, Classify equipment according to those Medical Supply Catalog designations for unit equipment which it most closely approximates (see section: "Industrial Dispensary Supplies and Equipment," ASP Manual M210). Indicate other major equipment or accessible facilities under Item 9. Items 7-2 Entries In these items will he based on W.D., A.0.0. Porn No. 8-175, COMPILED DAILY AND MONTHLY TALLY SHEET. 7a 1 Occupational Illness; Under Number of Cases per month enter total from Column 9 ("New Illness") for corre- sponding month on TALLY SHEET, Under Number of Treatments per month enter sum of totals from Column 9 ("New Illness") and Column 10 ("Old Illness") for corresponding month on TALLY SHEET. 7a 2 Occupational Injury: Under Number of Cases per month enter total from Column 7 ("New Injury"), for corre- sponding month on TALLY SHEET. Under Number of Treatments per month enter sum of total from Column 7 ("New Injury") and Column 8 ("Injury Redressed") for corresoonding month on TALLY SHEET, 7b Non-occunatlonal Illness and Injury; Under Number of Cases per month enter total from Column 11 ("Number Cases") for corresponding month on TALLY SHEET. Number of Days Lost, (for Occupational Illness and Non-Occupational Illness and Injury). Entries will be based on data assembled from W.D., A.G.O. Form No. 8-172, MEDICAL ABSENTEE RECORD 8a-8h, Enter sum of totals for columns similarly titled on TALLY SHEETS for the three months covered in the quarterly period (e.&., for Item 8a, Prenlacement Examinations, add totals of Column 2, ("Preplacement") on TALLY SHEET for January, February, and March, or whichever three months are embraced by the report). Item 9 State major causes for "Rejections," Item 8d above. Also include here any preven- tive medicine activities for data not pre- viously covered (e.g., material compiled in columns U and 17 of TALLY SHEET), Note any health education program in effect, such as Safety, Nutrition, Personal Hygiene, Public Health, Control of Sick-Absenteelsm, etc. Indicate when significant, predomi- nant types of illnesses treated for Items 7a 1 and Jb above. Include comment on any condition that needs correction. Figure 8. WD AGO Form 8-177, Quarterly Occupational Health Report. Reverse side. 24 examinations, laboratory tests, medical treat- ments, etc., performed upon that day. Under “Preplacement” (Physical Examinations: Ex- aminations Given) include reemployment as well as preplacement examinations; under “Pe- riodic” all recheck examinations against occu- pational hazards or for handicapped employees; “Other” examinations might include annual ex- aminations, terminal examinations, examina- tion of employees for oversea assignment, etc. Under “Chest X-rays” enter the number of pic- tures taken in connection with preplacement examinations or for routine or mass tuberculo- sis surveys; diagnostic X-rays made on em- ployees individually would appear under one of the Treatment categories. The “Miscellaneous” column designated “Other” may be used to in- clude treatments, tests, clinics or activities not otherwise covered; the classification may be written in. 49. Quarterly Occupational Health Report The Compiled Daily and Monthly Tally Sheet Form is the basis from which most of WD AGO Form 8-177 (Quarterly Occupational Health Report) Control Approval Symbol MDO 1-115, is completed. (See fig. 7.) Directions for the accomplishment and submission of this lat- ter form are included on its reverse side. (See fig. 8.) The data on the number of days lost for occu- pational illness (Item 7a) and for nonoccupa- tional illness and injury (Item 7b) may be taken from the tallied work sheet described in para- graph 44. It should be noted that these data represent accumulated time lost; consequently, the entries for days lost in each month reflect the number of days reported lost during that month. Absences occurring during one quarter but not terminating, and not computed, till the next quarter, will be carried in the report for the subsequent quarter. SECTION VIII INDUSTRIAL DISPENSARY BUILDINGS 50. Standard Floor Plans Figures 9 and 10 show floor plans of standard U. S. Army industrial dispensary buildings. (See frontispiece for exterior view of typical construction.) Two main types of structures are recommended, 108' by 40' and 140' by 40'. These dispensaries are suitable for the central med- ical department of an industrial installation and have proved to be generally adequate for instal- lations ranging from 2,000 to 15,000 employees. The basic plan from which these buildings are drawn is capable of expansion when and if nec- essary. It will be noted that one of the main differences between the two floor plans is the size of the X-ray rooms. Generally speaking, an X-ray is a valuable and a necessary adjunct to industrial medical practice. Depending upon the number of employees and the type of industry at the installation, a larger or smaller X-ray machine is required. 51. Advantage ot Standard Plans An advantage of the standard industrial dis- pensary as illustrated lies in the fact that these buildings have been approved by the Hospital Construction Division, The Surgeon General’s Office and the Office of The Chief of Engineers. If an industrial dispensary is required for an installation, and approved by the service com- mand and the Office of The Surgeon General, there is little delay in breaking ground for con- struction, as the intricate engineering details of these buildings have already been accom- plished. Savings in time-factor and architect and engineering fees are sufficient in impor- tance to overrule specific design changes in most instances. 52. Utilization of Existing Buildings Should existing building facilities be available in a new installation, the Office of The Surgeon FJL.1XOJX Di5P 5. A RY F-Ft OFFICE. OF THE. SURcSEOM GEMIRAU: Host* nr al division. CQ HSTRUETl D fcL BRANCH Figure 9. Floor Plan, Dispensary F-H. 25 26 F U"0 O R PIL^AT-J PISPEN S A P»Y TYPE - OlSP-G-H OFFICE Of THE, SURG EON -GENCRAE HOSPITAL, mvi 51 ON CONSTRUCTION BRANCH Figure 10. Floor Plan, Dispensary G-H. General will design interior renovation of such buildings provided sufficient square footage is available and the location of the building is suitable for a central industrial medical depart- ment. An adequate written request for the modification of such an existing structure should be sent through command channels to The Surgeon General’s Office if a separate in- dustrial dispensary building is not desired. Full reasons for this departure from standard pro- cedure should accompany any such request. 53. Required Approval According to existing regulations (par. 2, sec. IV, ASF cir. No. 178, 1944), “Any request for new construction, additions, or alterations (ex- cept items strictly for repairs or maintenance), the cost of which exceeds $1000, at Class I, II, or IV installations, must be approved person- ally by the commanding general of the inter- ested service command or the chief of the in- terested technical service and must contain complete justification for the proposed work.” SECTION IX INDUSTRIAL DISPENSARY SUPPLIES AND EQUIPMENT 54. Medical Supply Catalog Items In general, all medical supplies and equipment for use in the industrial medical program will be drawn from those items appearing in Army Service Forces Catalog, MED 3, a copy of which should be in every industrial medical depart- ment. If the catalog and catalog changes have not been distributed automatically, or if addi- tional copies are required, they may be obtained from adjutant general distribution depots in ac- cordance with Circular No. 2&4, War Depart- ment, 1944, which list the addresses and dis- tribution areas of these depots. 55. Standardized Unit Equipment Complete unit equipment (Items 9725603, 9725605, and 9725610 in ASF Cat. MED 3) for operating industrial dispensaries and aid sta- tions has been standardized, and will form the basis of requisition for initial equipment for these units. Lists of the component parts of these items may be requisitioned from adjutant general depots under the following stock num- bers and nomenclature: Army Service Forces Catalog, MED 10-16, Miscellaneous ZI Units, Item 9725603, In- dustrial Dispensary No. 1 (when pub- lished) . Army Service Forces Catalog, MED 10-16, Miscellaneous ZI Units, Item 9725605, In- dustrial Dispensary No. 2 (when pub- lished) . Army Service Forces Catalog, MED 10-16, Miscellaneous ZI Units, Item 9725610, In- dustrial Dispensary Aid Station (when published). Medical officers and physicians in charge of industrial dispensaries and aid stations will as- certain that these units are equipped with a minimum of the supplies included in the ap- plicable unit equipment item, as follows: a. Item 9725603, Industrial Dispensary No. 1, contains complete equipment for an industrial dispensary building or for a dispensary with a floor space of 4,000 to 5,000 square feet. This list is considered adequate to enable the med- ical department to give emergency medical or surgical care as well as preplacement or pe- riodic physical examinations including neces- sary laboratory work. b. Item 9725605, Industrial Dispensary No. 2, includes additional Roentgen Ray equipment for taking 4" by 5" photo-fluorographic films. This equipment will be issued only to those stations where there are over 10,000 civilian employees and where adequate medical department person- nel are available for properly operating this equipment. This item must be requisitioned with written explanation as to its need and the abil- ity of the station to use it properly. Approval by the Office of The Surgeon General is neces- sary. c. Item 9725610, Industrial Dispensary Aid Station, contains necessary items for equipping a first-aid station. This equipment is adequate for a room at least 20' by 20'. First-aid stations are designed to be run by nursing personnel, and a requisition for Item 9725610 will not be approved unless nursing personnel is available for such a first-aid station. 56. Nonstandard Items There are instances in which specific medical items not included in the above equipment lists may be necessary at individual stations. Should such be the case, a requisition for needed items will be forwarded, together with an adequate written explanation of the necessity for the requisition, to the medical supply depot serving the installation. These requisitions must be ap- proved by the Office of The Surgeon General before issue. Wherever possible, items listed in the Medical Supply Catalog will be requested. 57. Emergency Purchases Subject to conditions set forth in section VII, War Department Circular No. 310, 20 July 1944, small quantities of items immediately needed to save life or prevent suffering and dis- tress may be purchased without prior authority. Necessary vouchers and forms which must be submitted in such cases are described in para- graph 75(2), AR 40-1705. 27 28 58. Assistance in Obtaining Medical Supplies For general assistance in obtaining medical sup- plies, and recommendation regarding nonau- thorized items, the post industrial medical offi- cer or physician is advised to contact the des- ignated industrial medical officer at the head- quarters of that service command in which his station is located. For specific information re- garding the determination of stock levels and inventory requirements, the maintenance of stock record cards, issue slips, and other record forms, and the procedure and channels for sub- mitting requisitions for initial and replenish- ment supplies, the industrial medical officer or physician is advised to contact the nearest med- ical supply officer or medical distribution depot. The following depots have been designated for the issue of medical supplies to stations within the continental United States (their respective distribution areas are shown on the map in fig. 11) : Binghamton Medical Depot San Francisco Medical Depot Binghamton, New York. 1855 Folsom Street _ San Francisco 1, California. Denver Medical Depot 3800 York Street Medical Supply Officer Denver 1, Colorado. (Thru: Commanding Officer) Savannah ASF Depot Los Angeles Medical Depot Savannah, Georgia. 2001 S. Alameda Street , __ Los Angeles 54, California. S . (Thru: Commanding Officer) St. Louis Medical Depot Seattle ASF Depot 12th & Spruce Streets 4735 E. Marginal Way St. Louis, Missouri. Seattle 4, Washington. DISTRIBUTION DEPOTS MEDICAL DEPARTMENT Effective I July 1944 Figure 11. Distribution depots. note; 1. ALL CALIFORNIA INSTALLATIONS SITUATED NORTH OF A LINE DRAWN FROM MONTEREY TO BRIDGEPORT AND INCLUDING THESE CITIES, ARE ASSIGNED TO THE SAN FRANCISCO DEPOT; ALL SOUTH OF THIS LINE TO LOS ANGELES. 2. ALL TEXAS INSTALLATIONS SITUATED WEST OF LINE DRAWN OUST EAST OF WICHITA FALLS, MINERAL WELLS, 6R0WNW000, AND THE JUNCTION OF THE PECOS AND RIO GRANDE RIVERS ARE ASSIGNED TO THE DENVER DEPOT; ALL EAST OF THIS LINE TO ST. LOUIS DEPOT. 3. D.C., FT. MYER, VA. AND FT. BELVOIR, VA, ARE INCLUDED IN THE DISTRIBUTION AREA OF BINGHAMTON MEDICAL DEPOT. More detailed instructions are contained in the following publications: Army Regulations 40-1705, Medical Sup- plies, 2 November 1942, and Changes. TM 38-403, Station Supply Procedure, 1 August 1944. TM 38-220, Stock Control Manual for Posts, Camps, and Stations, 9 May 1944 (particularly sec. IX). War Department Supply Bulletin SB 8-13, Sources of Medical Supplies for all Ports of Embarkation and all Posts, Camps, and Stations in Continental United States, 27 September 1944, and Changes No. 1, 15 February 1945.