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13 * 10: 19 



fED STATES DEPARTMENT OF LABOR 

FRANCES PERKINS, Secretary 

WOMEN'S BUREAU 

MARY ANDERSON, Director 

+ 



The Industrial Nurse 

and 

The Woman Worker 



By 

JENNIE MOHR 




Special Bulletin No. 19 of the Women’s Bureau 



UNITED STATES 

GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1944 



For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C- 

Price 10 cents 



LETTER OF TRANSMITTAL 



United States Department of Labor, 

Women’s Bureau, 
Washington, May 24, 1944- 

Madam: I have the honor to transmit a report analyzing both 
broadly and in detail the widening field of responsibility on the part 
of the industrial nurse and the vital importance of her being informed 
as to working conditions, actual and desirable; occupational hazards 
and accident prevention; plant service and food facilities; the per- 
sonal problems that lower women’s efficiency on the job; and other 
developments of the war years. 

It is being increasingly recognized by employers, industrial phy- 
sicians, industrial nurses, and workers that the nurse has a great 
opportunity to help in the solution of such problems and in the edu- 
cation of workers in matters of health and safety. This report is 
directed particularly, therefore, to nurses in industrial plants; but 
it is hoped that the presentation of some of the factors involved in 
the employment of women will be of use also to those in such depart- 
ments as personnel, safety, and training. 

The report is the work of Jennie Mohr, of the Bureau’s Research 
Division. 

Respectfully submitted. 

Mary Anderson, Director . 

Hon. Frances Perkins, 

Secretary of Labor . 

n 



CONTENTS 



Page 

Letter of transmittal n 

I. The Women Come to the Nurse 1 

II. Getting Tired Out 5 

Long hours of work 6 

Posture 6 

Home responsibilities 7 

Monotony 7 

Physical environment 8 

Lighting 8 

Noise 8 

Ventilation and heating 8 

Night work 9 

Personality factors in fatigue 9 

III. Everyday Good Health Habits 11 

We are what we eat 13 

Nutrition education 13 

Existing facilities in the plant 15 

Personal hygiene 16 

Cleanliness 16 

Care of the feet 17 

Care of the teeth 18 

Care of the eyes 18 

Health in the home 19 

Mental hygiene 19 

IV. Health and Safety on the Job 21 

Health Problems in the Plant 21 

General health factors that carry over into the job 21 

The common cold 21 

Good food 22 

Service facilities 22 

Health factors having to do with the job itself 23 

Physical strains 23 

Posture 25 

The tools and the lay-out of the job 25 

Special health problem^ of women 26 

Menstruation 26 

A maternity policy in industry 27 

The menopause 29 

Occupational diseases 30 

Safety on the Job 33 

The need to be aware of safety problems — 33 

The kinds of accidents that women have 33 

Helping the women to be safe 36 

Safety clothing 36 

Hazardous jobs 36 

An open eye for bad spots 37 

V. Taking Part in a Health and Safety Program in the Plant 38 

Health committees 40 

The plant paper 41 

Leaflets, posters, pamphlets, and films 41 

List of industrial nursing consultant services 42 

Sources Referred to in Text 44 

Additional Suggested Readings 45 

General 45 

The nurse’s part in a health and safety program 46 

Fatigue ’ 46 

Special health problems of women 47 

Nutrition 47 

m 



The Industrial Nurse and the Woman Worker 



L THE WOMEN COME TO THE NURSE 

From the towns and from the farms, from homes and shops and 
offices, women are coming into war plants to make the machinery of war. 
They are building tanks and planes and ships and guns. Much of the 
work is strange to them, but there is no question about the effective- 
ness with which they are doing it. As men are being transferred to 
military service, women are filling the gaps in industry in increasing 
numbers. They are spreading into jobs that a few years ago no 
one would have expected them to fill. Some of these jobs are fairly 
light and obviously suited to women’s physical abilities and experi- 
ences. Others are heavy, dirty, and sometimes dangerous. All of 
them, if war production schedules are to be maintained, require regu- 
lar attendance and efficient performance. 

At the same time, for the sake of the women themselves, their safety 
must be preserved and their health guarded. Thus the need for care- 
ful consideration of the well-being of women workers is twofold. 
It arises from the demands of war and from the need to protect the 
lives and the health of workers. These two needs are really one and 
the same ; good performance cannot be given by sick or injured workers. 

When women come into industry, new problems arise that were not 
there before. Some of these problems always arise among women 
workers, regardless of where they work. Others are peculiar to the job 
or the industry and, in cases of occupations unusual for women, are 
arising now for the first time. Here are a few of them : 

1. Most of the women now coming into the plants are inexperienced, 
particularly inexperienced in the kind of work they are to do. Two 
factors make this a special problem : First, because most women have 
had not even casual experience with machines and tools and are un- 
familiar with mechanical things and terminology, they are likely to 
feel greatly at a loss, at the outset, in dealing with such matters. 
Second, they find the factory environment strange and difficult to be- 
come adapted to. The size, noise, movement, confusion, often are 
overwhelming. Especially for the housewife coming into a factory 
for the first time, the importance of such things looms large. She 
has been used to working hard and steadily, but it has been independent 
work, at her own pace, according to her own plan, and in the security 
of her own home. 

2. When women first came into war jobs they were carefully selected. 
Especially, age limits were set; often 18 to 35 years, or 20 to 40, was 
considered not only the most desirable but the only suitable age group. 
Gradually this idea was given up, partly because there were not 

1 



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INDUSTRIAL NURSE AND WOMAN WORKER 



enough women of these ages, partly because it was discovered that a 
woman past 40 is able to hold her own on many jobs. Now in many 
places there are no age limits at all. This change not only opens 
opportunity to older women ; it places more responsibility on manage- 
ment in the selection of women, responsibility to see that in employing 
older women they still preserve good health standards. At the other 
end of the age scale, the introduction of young girls into factories 
also brings new problems. These girls, many of whom are now under- 
taking their first job, have no experience to guide them in handling 
themselves and their work. They have little or no maturity of judg- 
ment that might help them to adjust to the environment; they have 
no knowledge of what is to be expected of them or what they may 
expect of others. 

3. Many of the women are married, have homes and children. 
Frequently they have no relief from their home responsibilities when 
they start in on a factory job. Consequently, they are doing two jobs 
at once. On top of a full day’s work in industry, they must run the 
home, prepare meals, care for children, do the shopping and the mend- 
ing and the innumerable other household tasks. What does this 
double burden do to their efficiency on the job? How does it affect 
their health and their staying ability? To what extent should the 
plant nurse undertake to aid them in dealing with these questions? 

4. An obvious problem is that of the physical capacities and re- 
quirements of women. Though of course there are wide differences 
among women, they have on the average a little over half the physical 
strength of men. This means that generally they cannot do, unaided, 
the heavy lifting, carrying, pushing, and pulling that some jobs 
require. Their structure is different — on the average their height is 
less than men’s, their hands and feet are smaller, their muscles, espe- 
cially of the feet and legs, are quicker to tire. Therefore, the suita- 
bility of equipment that ordinarily is used by men must be considered. 
Are tools too large to grasp or too heavy to wield ? 

5. It is sometimes as much of a problem to get the factory adjusted 
to the Tvomen as to get the w r omen adjusted to the factory. There is 
scarcely a corner of “man’s world” that is not being invaded by women. 
And naturally enough this is hard on the men. Consequently, they 
are likely often to resist the invasion — resist it by means of hostility 
and refusal to accept the women workers. Natural though such an 
attitude may be, it has of course no place in the present scheme of 
things; and the men — workers, supervisors, sometimes top manage- 
ment too — must be helped to understand that fact. In the meantime, 
the women are faced with this situation, and it is obvious that, on top 
of their general industrial inexperience, it adds another problem to 
be considered. 

All these factors affect the production of the women workers. It 
would be the height of unwisdom to ignore them — especially when, 
with understanding and vision, they can be handled. In the course of 
this study other questions that affect similarly the success of new 
women workers will be mentioned. In general, it may be asked at 
this point : What is to be done about these problems ? 

Particularly, the question is: What can be done by an industrial 
nurse who is concerned immediately with the health of the workers 
in the plant? How can she best help to assure the maximum effi- 



THE WOMEN COME TO THE NURSE 



3 



eiency of these new women workers ? Most obvious is her place in the 
medical service of the plant, her special concern for the injuries and 
illnesses that arise in the course of the day’s work. But whatever the 
specific task, the nurse is in a position to give the women guidance. 
This does not mean assuming responsibility for their personal prob- 
lems, or for their relationships within the plant, or for their difficul- 
ties on the job. But because of the nurse’s role in the organization, 
women turn to her for help. It may be well to examine in some detail 
the particular places in which her help is asked, and how such requests 
fit in with her job in the plant. 

Industrial nurses are different. The very fact that they function 
in the plant dispensary or hospital or first-aid station rather than in 
a hospital or private home is a major cause of the difference. This 
setting, and the immediacy of the sources of injury or illness, cannot 
be ignored. Industrial nurses are on the spot, in the plant. Right 
before their eyes are the sources of trouble ; they are in a position to 
see what these sources are. 

Again, the health problems that come to the nurse often are 
directly related ^to many factors, in both work and home. These 
factors, which* in some detail later, may have to do 

with the physical demands of the job or with the working environ- 
ment; with the routine of factory regulations; or with health or other 
problems within the home. They are the matters on which women 
go to the nurse for guidance, and they affect very directly the per- 
formance of the women on the job. The nurse’s function, then, is 
something in addition to that of a hospital nurse, because she is 
confronted with nonmedical problems that directly affect the health 
of the workers and their productivity. 

Among employers, industrial physicians, and industrial nurses, it 
is becoming widely recognized that the nurses have this widening field 
of work. Industrial medical practice is developing increasingly a 
preventive program; it is designed to keep people well, not only to 
cure them after they become ill. Consequently, stress is being put on 
the part that the nurse can play in helping with this prevention pro- 
gram. At the end of this pamphlet is a list of references to articles 
by industrial physicians and nurses that clearly state this purpose. 

The specific points at which guidance is needed, and can be given 
by the nurse, will be discussed in the pages following. Here are a 
few examples : 

Margaret C. works on the graveyard shift. She is married, but has no 
children. She keeps house, which is not an excessive burden on her because 
it is in a small apartment and her mother lives near enough to come to 
the rescue in case of emergency. But Margaret C. is subject to severe 
headaches. She has had them for years and since she came to the plant 
they have increased in frequency and intensity. The doctor told her that 
she is not getting enough rest, not enough sleep, and that she is not eating 
the right food. But how can she? She has been on the job for 3 months 
but still has not learned to sleep well in the noise of the day ; and she cannot 
get into proper eating habits in the topsy-turvy schedule of the night 
shift. She has been staying away from work — 2 days this week, 1 last 
week, 3 days the week before. 

Margaret goes to the medical department for some anacin, hoping that 
it will make her feel better able to stay the night through. She tells the 
nurse about the headaches, the irregular, sketchy, pick-up meals, the strain 
of working nights and trying fruitlessly to sleep days. “What shall I do?” 
she asks. 



4 



INDUSTRIAL NURSE AND WOMAN WORKER 



Frances R. operates a couple of grinders in the tool-grinding depart- 
ment. She sharpens drills: Small drills, sometimes no larger than an 
embroidery needle, on the rotary grinder; larger ones, perhaps two inches 
or more in diameter, on the rocker grinder. Frances stands at the job all 
day; and even though she is provided with a wooden platform to keep her 
feet off the cold cement floor, she gets pretty tired. 

Frances finds her way to the nurse’s office, too. “I’ve been menstruating 
twice as long as usual since I’ve been on this job,” she says. “I’ve always 
suffered a good deal of pain, but now it seems worse than ever. I think 
standing all day has something to do with it. And besides, those tote boxes 
are pretty heavy when I have to return the drills and fetch new ones. I 
know I’ve been told not to lift too much; but on a day like this almost 
anything is too much. What can I do about it?” 

Ruth M. is 35. She has been working in the plant for about 6 months, 
and has talked with the nurse — once when she had a slightly cut finger and 
once for a few minutes in the women’s rest room. The nurse remembers 
thinking what a capable, sensible, attractive woman she seemed. 

Now she goes in with a pass from her foreman and asks the nurse to 
countersign it. She is ill, and wants to go home. “No, nothing particularly 
wrong ; I’ve just got a terrible headache, and I can’t stay.” She looks very 
distressed, and the nurse wonders if it is just a headache. And before long 
Ruth begins to talk. She really has a headache, but that is the effect, not 
the cause. “My mother simply can’t be left alone in the house any more — 
she is too sick; I am always terribly afraid something will happen to her 
while I’m at work. She needs a doctor’s care, and maybe she should be in 
a hospital — I just don’t know. Most nights I am up taking care of her, and 
I’m all worn out and don’t know what’s best to do.” 

Mary C. goes storming into the dispensary. “Can you give me something 
for a cold — I’m getting a nasty one, the third I’ve had in the 2 months I’ve 
been here. I tell you, that room is so drafty and cold I don’t see how anyone 
keeps well in it. And when I put on my sweater the safety inspector comes 
along and tells me it’s dangerous to wear it around my machine. So I either 
freeze or get caught in the press. I don’t know which would be worse.” 

Not only the health of the women but their performance in the plant 
depends in some measure on what the nurse does about these women 
who go to her for help. She can get at the reasons why they are 
absent, or quit their jobs. She, perhaps better than anyone else, can 
discover from them conditions within the plant that hamper their 
production, conditions that might well go unrecognized or ignored by 
the supervisors who are concerned with getting out the product of 
the plant. She can help these supervisors to increase that output by 
helping to remove some of the things that slow it up. This bulletin 
is the story of such opportunities in a nurse’s job, and some of the 
ways in which she may take advantage of them. 



n. GETTING TIRED OUT 

Women come into the dispensary and complain of being “too tired 
to work.” Or they show signs of “wearing out,” and sometimes quit 
their jobs because they can no longer stand the strain. Still other 
women keep going but have to make more and more of an effort to do 
so ; or their production slows down ; or the number of their accidents 
or illnesses increases. These changes may be signs of fatigue. To 
help the women to remain well and be effective workers, the nurse must 
know what is the basis of their inability to carry on their work. The 
following paragraphs point out some of the causes she may discover. 
Some of them she can deal with directly ; others can be removed only 
by winning the understanding and cooperation of supervisors, man- 
agement, or other agencies. In all cases her first need is to know why . 

A great many studies have been made of the fatigue of industrial 
workers. From them one significant fact has arisen clearly. This 
is, that there is no simple element, fatigue, that can be recognized 
and isolated and measured. Father, fatigue is a word that is used 
to describe a whole group of conditions, both within the worker and 
in the environment. Some authorities hesitate to use the word at all, 
because it means too many things. But often it can be applied use- 
fully to the situation in which a worker’s ability to stay steadily on the 
job, and do a full day’s work, becomes gradually lessened. The con- 
cern here is with some of the conditions in the environment and the 
job that might help to bring on this situation. 

Dr. Alice Hamilton, an outstanding authority in the field of indus- 
trial medicine and formerly of the Harvard Medical School, puts it 
this way (1) : 1 

For a long time industrial fatigue was considered a rather simple problem, 
something for physiologists to determine by chemical or mechanical tests 
that could be applied to workers in the field just as well as to laboratory 
subjects, but the more the problem has been studied, the more complicated 
it has been found to be. Fatigue is influenced not only by hours of work 
but by other environmental factors, such as long or short periods of uninter- 
rupted work; by heat, cold, humidity; by lighting; by posture; by the 
worker’s skill or lack of skill ; and by the worker’s mental attitude toward his 
job and his pay, his fellow workers, and his supervisors. 

Others have shown that still more factors are involved than those 
mentioned by Dr. Hamilton. These various causes act on the worker’s 
mind as well as his body. Dr. R. R. Sayers, director of the Bureau of 
Mines, United States Department of the Interior, points out (2) 
that — 

Environmental conditions and relations with management and fellow 
workers are more important factors in fatigue than physical activity except 
in the “heavy” industries that require hard physical labor. 

It is neither necessary nor possible to explore here all the factors 
that create fatigue. But some of the more obvious reasons why 
women find themselves tired out may be indicated. 

1 References in parentheses throughout this report are to “Sources Referred to in Text,” 
p. 44. 



-2 



593702*— 44- 



5 



6 INDUSTRIAL NURSE AND WOMAN WORKER 

Long hours of work. 

It is recognized generally that excessive hours of work, required 
over long periods of time, are a health hazard. It is not known how 
long a workday is the best for women, producing the most work of 
best quality with least exhaustion. But many studies that have been 
made indicate that fatigue arising from a long workday may be a 
serious obstacle to sustained and efficient work. 

Dr. Isador Lubin, United States Commissioner of Labor Statistics, 
says (3) : 

It can be proven by medical evidence that the amount of fatigue increases 
at a more than proportional rate as you go beyond a certain number of hours 
a day * * *. There is evidence to show that the eighth, the ninth, and 

the tenth hours do not result, in many industries, in as much output per 
man as any of the first 6 or 7 hours. 

There are other factors besides production that appear to be related 
to the length of the working day or working week. Among them are 
the amount of spoilage, lost time, rate of accidents, and turn-over. 
Of these, the factors that would most easily come to the nurse’s atten- 
tion are lost time — especially that due to illness — and the rate of ac- 
cidents. One of the studies by Dr. II. M. Vernon, eminent British 
authority (4) , indicates that increasing the hours of work produces a 
greater increase of accidents among women than among men. In a 
group of women workers in a munitions plant he found that the num- 
ber of cuts suffered in a 12-hour day was nearly 2% times that in a 
10-hour day, whereas among men the number was increased by only 
14 percent. This cannot be taken as a certain measure of fatigue, 
however, as other elements may be involved. But if the nurse finds 
that any of these factors, such as absenteeism, accidents, or turn-over, 
are serious among the women in the plant, she should consider whether 
they may be due to long hours of work. Her records of the women 
coming in for attention will furnish useful evidence in showing the ef- 
fects of a fatigue that may be caused by too long a working day or 
week. Standards recommended by government agencies (3) include 
an 8-hour day, 6-day week, adequate meal period, and vacations. 

Posture. 

That poor posture plays an important part in the development of 
fatigue has been shown by many who have studied the question (5). 
Correct posture depends on two things : Sitting well, and having the 
right kind of chair to sit on. Of course it ^s possible to sit correctly 
on anything — a box or boards, for example. But it takes a good deal 
more effort to do so than if one has a properly designed chair. 

Dr. J. R. Garner, an authority on posture, describes (6) the close 
relation between posture and fatigue. He points out that a slouched 
posture impedes the action of the heart, the circulation of the blood, 
and the processes of elimination. It jmts pressure on the abdominal 
organs and may help to bring about displacement of the generative 
organs. 

The encouragement of proper seating, both by explaining to the 
women the need for good posture and by convincing management of 
the need for good seats, is one important way in which the plant nurse 
(^f'oQontribute to the relief of fatigue of the women workers. It has 
bet^itkifigu that continuous sitting, as well as continuous standing, is 



GETTING TIRED OUT 



7 



tiring. Man}' jobs can be done in either position, but often it is found 
that the women in such jobs are always standing or always sitting. 
Alternation should be encouraged wherever it is possible. 

In a study of the fatigue of 325 workers Dr. Vernon (7) says: 

* * * Of the 325 workers * * * half complained of bodily fatigue. 
A quarter of the complainants said that they “felt tired all over,” whilst a 
third of them felt tired in the back, neck, and shoulders. This seemed to be 
due to their working continuously in a sitting posture, for the operatives who 
had to stand whilst working frequently complained of fatigue in the legs. The 
fatigue felt by the two groups of workers would have been considerably 
reduced if they had sat and stood alternately at their work, for 86 percent of 
them stated that they preferred such an arrangement to a fixed posture. 

Home responsibilities. 

It is an oft-repeated story that women with homes and children to 
care for face a double responsibility when they take an outside job in 
addition. Indeed, a large part of the difficulty that women have in 
keeping going, day after day, may be explained by the fact that their 
hours away from work are filled with duties that allow insufficient 
time for recreation, rest, and sleep. This is true not only of married 
women with children, but of others who also have home duties and 
perhaps have dependents as well. 

In most communities there are various agencies established to pro- 
vide services for residents of the community. A nurse can inform 
herself as to what these agencies are in her own region and help the 
harassed worker to get aid from them. 

Monotony. 

One of the features of the large-scale employment of women in 
industry today is that many of their jobs are of an extremely simple 
and repetitive nature. In fact, to be able to use these inexperienced 
workers quickly it has been necessary to break down many of the 
more skilled jobs into very simple parts, and to train the women to 
do only one or a few of these parts. 

The extent to which the monotony of such work tires the women 
depends largely on the individual; one man’s meat is another man’s 
poison, and the job that seems completely satisfactory to one woman 
may build up in another a restlessness or a tension that results in 
extreme fatigue. One writer points out (8) that boredom is ex- 
perienced less when a job is fully automatic than when it is only semi- 
automatic. If it is such as to demand practically no concentration 
or attention, the worker can do it and keep her mind (and perhaps 
her conversation) on other things. But when it takes enough concen- 
tration to prevent this mental ’relaxation, and at the same time not 
enough to catch and hold the interest, then it is truly monotonous. 
The same situation is described by Dr. Hamilton (9) : 

Unskilled work is on the whole more fatiguing than skilled, because it 
does not occupy the worker’s mind. A man who has to think about his 
work is less susceptible to fatigue. With the introduction of the machine 
there often comes a loss of initiative on the part of the employee, who is, 
it is true, expected to work faster and to control more and more compli- 
cated machinery but whose work, even to individual motions, is planned in 
detail for him. His interest in it is apt to be lost very soon in boredom. 
On the other hand, if work is so completely automatic as to require almost 
no attention, it may not be boring because the worker can talk or day-dream 
as he pleases. It is in semiautomatic work, of a repetitive kind, that fatigue 
from boredom is most common. 



8 



INDUSTRIAL NURSE AND WOMAN WORKER 



The answer to the question of fatigue caused by monotony is fre- 
quently found to be in short rest periods. A number of plants intro- 
ducing rest periods found that they were helpful not only to those 
workers who needed the time because of the heavy work they were 
doing, but also to those who needed a change from light, repetitive 
work. Dr. Hamilton remarks (10) that — 

The effect of too long hours on repetitive work is shown most clearly in 
the mental attitude of the worker, which is one of bitter, pessimistic pre- 
occupation, and by irregular attention to the work. This attitude was 
found to disappear in the majority of cases by the simple expedient of 
breaking the monotony and lessening fatigue by rest periods. 

Physical environment. 

The physical conditions of work play a large part in preserving or 
diminishing a worker’s staying-power on the job. Some of the im- 
portant factors are these : 

Lighting . — Thirty-nine percent of all workers of 30 years of age 
are handicapped visually (11). This means that not only the older 
worker, whose vision may tail with his years, needs the protection of 
good lighting, but others as well. The American Standards Associa- 
tion Recommended Practices bulletin points out that even those with 
perfect vision “find, under good lighting, a noticeable improvement in 
eye comfort which results in reduced fatigue.” (12) 

The advantages of good lighting listed by Allen D. Brandt and 
Harry E. Seifert (13) include, among others: Greater ease of seeing, 
especially among older employees, thus making them more efficient; 
less eyestrain ; and improved morale. 

Noise . — It is well known that a noisy environment is conducive 
to fatigue. A study of “Noise and Its Effect on Human Beings” (14) 
indicates that there is also danger of actually impairing the hearing, 
and that the efficiency of workers may be diminished in a noisy en- 
vironment. The Bureau of Women in Industry of the New York 
Department of Labor has studied the effects of noise on the hearing 
of industrial workers (15), and recommends that tests of hearing and 
periodic examinations be made where workers are exposed to excessive 
noise. 

Dr. Vernon points out (16) that individuals vary greatly in the way 
they react to excessive noise, and that some attempt should be made 
to discover which workers are particularly susceptible and likely to 
develop nervous symptoms when so exposed. 

Brandt and Seifert (17) list four ways of reducing or eliminating 
the hazards of noise: (1) Elimination of noise at its source, (2) isola- 
tion of noisy operations, (3) reduction of noise by sound insulation, 
and (4) the use of personal protective devices against noise. 

An awareness of these possibilities, and knowledge of the apparent 
effects of noise on individual workers, will help the nurse to encourage 
the proper steps to be taken against this hazard. 

Ventilation and heating . — The importance of uncontaminated air 
and suitable temperatures in which to work is obvious. Not only is it 
necessary to protect the workers exposed to special hazards, such as 
dusts, fumes, gases, and vapors, or to extremes of cold and heat; 
steady efficiency and continued good health require for all workers 
surroundings that maintain recognized standards of ventilation and 
heating. Discovering what these standards are, and seeing that they 



GETTING TIRED OUT 



9 



exist in the plant, are the responsibilities of both safety and medical 
departments. But when the women go to see the nurse because of a 
cold, or a sore throat, or because they find they have to spend time and 
energy fighting an uncomfortable environment, she can do a lot by 
discovering the extent to which unsuitable air or unhealthy temper- 
ature contributes to their special difficulties. 

With respect to all the factors that make up the physical environ- 
ment of the worker, the nurse can exercise a similar watchful control. 
She can call to the attention of the responsible officials the conditions 
she has reason to believe are causing discomfort or illness, and urge 
that they be remedied. 

Night work. 

The conviction is general that night work is undesirable for 
women. However, in view of the widespread use of three 8-hour 
shifts during the war, and the not uncommon system of shift rota- 
tion, it is not practicable to set up a standard that invariably ex- 
cludes women from night work. What can be done is to keep an 
eye open for the evidences of fatigue or mental or physical disturb- 
ances appearing as a result of night work. 

It should be remembered, when shifts are rotated, that sufficient 
time must be allowed on each shift to permit the women to make 
adjustment to it. Rotation in periods of less than one month are 
for this reason too frequent. Two or three months probably should 
be the .minimum length of time on each shift. 

The disadvantages of both shift rotation and continuous night 
work are discussed by Dr. Beatrice Mintz in the New York State 
Industrial Bulletin (i8), in which the “evidence offered by physiolo- 
gists on the difficulty of changing sleeping and eating habits, making 
shift rotation a hazard to health and a factor in reduced output,” 
is balanced against “the well-known observations of increased fatigue 
on night work and the social isolation experienced by the night 
workers themselves.” 

It is especially important to keep in mind the fact that the women 
who are carrying on household duties are more subject to fatigue 
as a result of night work than are men or women without such 
duties; they are likely to run the household during the day when 
they should be sleeping. Consequently it is important for the nurse 
to know the conditions faced by the women on night shifts, to de- 
termine on an individual basis their ability to do night work, and 
to inform the supervisor assigning shifts about the women who, for 
such reasons, should be kept off night work. The health and effi- 
ciency of the individual, as well as such factors as equal distribution 
of night work, seniority, and the like, must be considered in deter- 
mining a valid basis for working at night. 

Personality factors in fatigue. 

Pushing a button, manipulating a gage, winding wire — whatever 
the process on which a woman is engaged — is only a part of “the 
job.” She is one of a group, often a very large and miscellaneous 
group. She spends 8 hours a day not only doing work but doing 
it with or among other people. And her relationship with these 
other people has a good deal to do with how tired she gets on the 



10 



INDUSTRIAL NURSE AND WOMAN WORKER 



job. The scientific study of fatigue made at a Western Electric 
Co. plant (19) gives much evidence showing that such factors may 
Lave as much or more to do with creating fatigue as the actual physical 
strain, or even the monotony, of the work itself. 

A well-known British industrial physician, Howard E. Collier, has 
pointed out (20) that fatigue may develop when a good deal of 
energy must be expended to counteract the effects of the environ- 
ment. He adds: 

It is for this reason that a cold shop, a nagging foreman or unhappy 
group relations in a workshop are found to be fatiguing by the worker. 

In protecting the worker against fatigue, it is important to know 
the psychological factors that produce fatigue. Collier points out 
that — 

* * * it is just “conditions of work” that lessen emotional fatigue 

that are of special importance in preventing industrial fatigue. Lack of 
sleep or insufficient rest are powerful causes of fatigue because they 
prevent or delay the restoration of depleted reserves of emotional energy. 
Moreover, it is recognized that * * * a feeling of insecurity is more 

fatiguing than indifferent ventilation * * *. 

In many cases help for the new woman worker in adjusting to her 
job must be continued throughout her work experience. The need 
for this arises largely from two facts. One is that her attitudes — 
toward supervision, training, discipline, and regularity of work 
habits — do not always fit in easily with the factory environment, 
and she must learn to make them do so; the second is that she is 
likely to carry with her to work the worries and problems that face 
her outside. It is easy to see that the added strain of these factors 
contributes in no small part to her fatigue. Therefore it is im- 
portant to learn the extent to which the women coming into factory 
work are having to deal with such problems, and how much the}' 
affect their ability to w'ork steadily and efficiently. 

Whatever the causes of fatigue, the extent to which it occurs in 
a plant is measured by what happens to the workers. This practical 
test is the nurse’s best means of discovering when factors, personal 
or environmental, are threatening the well-being and efficiency of 
the women in the plant. If she watches for the first signs of fatigue, 
the nurse can eliminate or diminish its causes before they lead to 
illness, absenteeism, and separations. 



III. EVERYDAY GOOD HEALTH HABITS 

The work of a nurse in a plant may be confined within the 8 hours 
of a working day and the gates of the plant property. But actually 
what she does finds its way into the lives and homes of the workers 
and their families. 

She can help workers to guard against many of the health hazards 
that threaten to impair their usefulness on the job as well as their 
security outside. To the worker, the foresight of this nurse is of 
enormous value. It protects the worker’s ability to stay on the job, 
to produce, and to maintain economic security. It means steady 
performance and steady wages; less to pay out for curing ills, be- 
cause there are fewer ills to cure ; freedom from the psychological and 
physical drag of ill health. 

The benefit to the employer of such aid on the part of the nurse is 
equally obvious. It means a healthier and steadier working force; 
it means less absenteeism and turn-over, smoother flow of work, bet- 
ter production. 

That this responsibility of the industrial medical department is 
commonly recognized is reflected in the words of Dr. C. O. Sapping- 
ton (21) , widely known industrial-hygiene authority : 

It has been repeatedly stated that the progress of the safety movement 
was greatly accelerated by “selling” every employee the idea that the safe 
way is the best way. This has its analogy in “selling health,” and it is 
a fundamental principle that the. employee must be convinced that good 
health or at least a fair degree of it is a basic principle upon which con- 
tinuous earning capacity is founded. * * * the employer wants to con- 
tinue his production as near the peak as possible; * * * the employee 

wants to continue to earn his wages without interruption. At the con- 
vergence of these two desires stands the field of industrial health through 
which these desires may be accomplished. 

Dr. Sappington goes on to explain why it is important for the 
worker to acquire health information easily — which should mean, in 
large measure, to get it at her place of work. The industrial nurse 
in the plant is in a strategic position to give it. The worker who 
goes to the first-aid station or dispensary is, as one writer puts it, 
psychologically ready to receive instruction. The nurse can take 
advantage of the immediate concern — a cut finger or a skin eruption, 
for example — to direct the talk to general health care. 

It is worth while to look at Dr. Sappington’s reasons why it is 
important to give the workers health education (21) : 

It is impossible to entirely separate the personal health of the employee 
from the purely industrial phases of health. As a matter of fact, personal 
health is indeed a part of industrial health work. It is further evident that 
no matter what provisions are made for the protection of the health of the 
employee within his working hours, any individual can upset his program 
of protection within industry by what he does outside of his working hours. 
It therefore becomes necessary to provide some way by which the employee 
m~y be informed concerning his personal health. 



11 



12 



INDUSTRIAL NURSE AND WOMAN WORKER 



It is surely fruitless and a waste of money and time to provide expensive 
equipment and extensive health service staff, unless the cooperation of 
employees can be secured in availing themselves of the opportunity of this 
service. This involves the continuous use of carefully gathered and widely 
disseminated health information. 

Where health service has been inaugurated, it is necessary that a constant 

. program of encouragement to make use of the facilities of the health service 
be promoted among the employees. This calls for constant reminders re- 
garding the importance of health and the principles of keeping well, and 
the fundamentals of health training. 

Good health certainly is of equal importance to men and to women. 
But in many of the practices that preserve and increase health, the 
attitude and the activity of a woman may be of more consequence. 
She is likely to be the one primarily responsible for running the home, 
preparing meals, looking out for the well-being of her family in terms 
of practical, everyday duties. She is in a position to apply at home, 
as well as on the job, the principles of good health which the nurse 
in the plant is able to give her. 

These principles, if they are to be useful, must not be elaborate 
or difficult to follow out. The way in which they are presented should 
be, as one authority has said, “simple, direct, practical, and brief” 
(22). It must be in language easily understood, and must not involve 
more than a working woman with a family to care for can be expected 
to do. 

Good health rests to a large extent on good everyday habits. Most 
people are likely not to bother about such things until something goes 
wrong. The idea of preventive health measures is not firmly rooted 
in the average person’s mind. It is part of the nurse’s job to make 
that idea become so constantly present in the minds of the women in 
the plant that they not only will get well but will stay well. 

Ways and means for conveying this necessary health information 
to the workers, and for getting them to realize its importance to them, 
will depend on the plant’s attitude toward health education, and will 
vary with the size of the force and the amount of work to be done. 
In some plants nurses remain constantly on duty in the dispensary ; 
and as the women come in to have ills and injuries taken care of, or 
to ask advice or talk over some special problem, the nurse can take 
the occasion to interest them in questions of health. In other plants, 
one of the nurse’s duties is to visit the places where the women are 
at work, or their rest or lunch rooms, to keep an eye on the conditions 
under which the work is done and the cleanliness and efficiency of 
the service facilities. Such occasions offer the nurse a chance to 
know the women, even those who do not come to the dispensary, and to 
arouse their interest. 

Again, a plant may have an educational program, which begins 
with the introduction of new workers into the plant and continues 
after they are on the job. Such programs, which may stress special 
problems for women, must be the result of cooperation among various 
departments, such as safety, medical, cafeteria, personnel, industrial 
relations. (See pt. V.) 

A few major points on which “selling health” to the women can be 
focused are these: Nutrition, personal hygiene, health in the home, 
and mental hygiene. 



EVERYDAY GOOD HEALTH HABITS 



13 



We are what we eat. 

From the cradle to the grave, a person is to a large extent formed 
by the food he eats. Dr. H. M. Vernon puts it strongly when he 
says (23) : 

We have good reason to think that of all the environmental influences 
reacting upon the child before and after birth, upon the school child, the 
adolescent, and the adult, nutrition plays the largest part. It controls 
growth and physique, it largely determines physical and mental health, and 
the capacity for avoiding and overcoming disease. 

That most of us have not been properly respectful of this power 
of food is recognized by the many health authorities who have become 
increasingly concerned with the health protection of workers, in nor- 
mal times and especially now with the increased pressures that war 
has brought. For example, a report of the National Research Council 
(24) shows that among employed workers’ families in various parts of 
the country, only 26 percent were classed as having good diets; 45 
percent had fair and 26 percent had poor diets. The standards used 
in this study were lower than those of the Food and Nutrition Board of 
the National Research Council. If the latter had been used, the re- 
sults would have been even less favorable. 

As far as women themselves are concerned, it is recognized that 
the diets of women workers generally are poorer than those of men 
workers. It has been pointed out that this situation is of increasing sig- 
nificance as greater numbers of women go into industrial work. One 
manager of a chemical plant in England found that his women em- 
ployees had much higher incidence of gastric complaints than the 
men but that this sex difference disappeared after the diets of the 
women were improved (25). Dr. Frank G. Boudreau, chairman of 
Food and Nutrition Board and Committee on Nutrition in Industry, 
National Research Council, points out (26) that there are three ways 
in which food deficiency can be dealt with: The first is education — 
workers cannot improve their health through proper eating unless they 
know what to eat; second, supplementing inadequate diets, a prac- 
tice carried on in a number of plants; third, enriching staple foods 
so that one can get from them some added essential nutrition. 

Of these three ways, two are of immediate concern to an industrial 
nurse. First, through her personal and constant contact with the men 
and women, she can help in teaching them what they should know 
about food; and second, by cooperation with those responsible for 
food facilities of the plant she can see that necessary kinds of food 
are available to the workers. 

Nutrition education . — As the National Research Council report 
points out (27), the most pressing need in the campaign to safeguard 
nutrition and promote health and efficiency is greater knowledge about 
food requirements on the part of every person. To aid in giving this 
knowledge, Government agencies, research foundations, and private 
concerns have done a great deal within the past few years to explore 
the nutritional needs of workers and to publish material that can be 
used in the fine art of persuasion. 

The Civilian Food Requirements Branch of the Office of Distribu- 
tion, War Food Administration, has developed material for health 
education programs for workers as well as programs for plant tech- 
niques in supplying food. This organization also has a field service, 

593702 ° — 44 3 



14 



INDUSTRIAL NURSE AND WOMAN WORKER 



which helps plants to establish food services and to secure food 
supplies, equipment, and personnel. Regional headquarters of the 
Office of Distribution from which such help can be obtained are these : 

'Northeast Region: 150 Broadway, New York 7, N. Y. 

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massa- 
chusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode 
Island, Vermont, West Virginia. 

S&uthei'n Region: Marietta and Forsyth Streets, Atlanta 3, Ga. 

Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South 
Carolina, Tennessee, Virginia. 

Midwest Region: 5 South Wabash Avenue, Chicago 3, 111. 

Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, North 
Dakota, Ohio, South Dakota, Wisconsin. 

Southwest Region: 425 Wilson Building, Dallas 1, Tex. 

Arkansas, Colorado, Kansas, Louisiana, New Mexico, Oklahoma, Texas. 

Western Region: 821 Market Street, San Francisco 3, Calif. 

Arizona, California, Idaho, Montana, Nevada, Oregon, Utah, Washington, 
Wyoming, Territory of Hawaii. 

Pamphlets, posters, and leaflets can be secured on request from the 
Office of Distribution, War Food Administration, and other agencies 
and can be introduced into the plant program by the nurse. At the end 
of this bulletin is a list of such material, together with the names of 
the organizations from which it may be had. 

How much can the plant nurse do to help the women learn to prepare 
adequate meals, and, what is more, to persuade them to eat them ? How 
much can she do to awaken the interest of all the workers in better 
health through better gating ? 

Pamphlets, leaflets, and fliers should be made easily available to the 
women, to be taken home. They should give suggestions about meals, 
information about the kinds of food that are neeeded by the body, 
ways of preparing the food, and what constitutes a balanced diet. 
The extent to which the nurse should or can be responsible for seeing 
that these materials are distributed to the women will depend, again, 
on the kind of educational program the plant has. But it is important 
for her to urge their distribution and their use. 

In talking to the women, whether individually or in groups, some 
primary facts about food can be given them. For instance, the nurse 
might explain : 

— A good guide to follow in order to supply the body regularly with 
certain needed foods is the use of the “Basic 7” food groups. The 
Civilian Food Requirements Branch of the Office of Distribution, 
War Food Administration, lists these basic foods as follows, and sug- 
gests that foods from each group be included in the diet each day : 

1. Green and yellow vegetables, raw, cooked, frozen, or canned. 

2. Oranges, tomatoes, grapefruit, or raw cabbage or salad greens. 

3. Potatoes and other vegetables and fruits. 

4. Milk and milk products or cheese. 

5. Meat, poultry, fish, or eggs, or dried beans, peas, nuts, or peanut butter. 

6. Bread, flour, and cereals — natural, whole-grain, enriched, or restored. 

7. Butter and fortified margarine. 

— The right food can be ruined by the wrong preparation. The ways 
in which food should be prepared in order to preserve its value are 
not harder, and frequently are easier and quicker, than other ways. 
Easy guides to the busy woman worker are available and can be 
distributed. 

— The woman who keeps an eye out for the foods that are in season, 
abundant, and on special sale can often plan a more nutritious and 



EVERYDAY GOOD HEALTH HABITS 15 

less expensive meal than if she stuck to traditional menus without 
regard to limitations of supply. 

— Above all, it is important to eat regularly and in sufficient 
amounts. All nurses who have worked in plants for any length of 
time know how generally women neglect or hurry their meals. Espe- 
cially among those working on night shifts, there is a great tendency 
to be sketchy about eating. Adjustment to a regular way of living 
on the abnormal schedule of a graveyard shift is not always easy. 
Many women, fitting in household duties during the daytime, fail to 
have regularity in hours either of sleep or of meals. The necessity 
for regularizing their program cannot be too strongly stressed, since 
the failure to do this is the quickest and most likely way of failing to 
get the needed supply of the right kinds of food. 

Eating facilities in the plant . — When the eating facilities of the 
plant come under the immediate supervision of the medical depart- 
ment, as they sometimes do, the nurse can keep an eye on them, with 
respect to both the kinds of food they offer and the cleanliness of the 
kitchen and the service. In any case she can urge the management 
of the cafeteria to offer the kinds of food the workers most need. At 
the same time she can point out to the workers themselves how impor- 
tant it is to make a proper selection of items as they go down the 
cafeteria counter. Details of the various problems of plant feeding 
should, of course, be in the hands of a trained nutritionist. When the 
size or organization of the plant does not permit the employment 
of a nutritionist. War Food Administration Office of Distribution 
industrial-feeding specialists should be called on to help with the 
problem. The nurse can encourage this practice by showing man- 
agement its large part in protecting the efficiency and health of the 
workers. 

There are a few points particularly relevant to the task of providing 
adequate food facilities. Among them are the following: 

— There is some evidence to show that the worker (especially one 
doing heavy manual labor) often gets the lion’s share of the family 
food supply. Therefore, if a good part of this need can be met in 
the plant cafeteria, there is likely to be a real improvement in the 
supply remaining for the rest of the family (28). 

— That the work in the plant definitely improves when proper eating 
facilities are provided is attested by many employers. Here are a few 
of their statements (29) : 

Production increased 10 percent due to improvement in morale in first two 
weeks after food service was set up according to recommendations of the 
Government’s Nutrition in Industry Division. — Hugh Comer, executive vice- 
president, Avondale Mills, Sylacauga, Ala. 

Absenteeism was cut 19 percent in first four months following installation 
of our Nutrition in Industry Program, which includes serving of Victory 
Lunch Specials providing balanced meals supplying more than one-third of 
the daily food needs — Servel, Inc., Evansville, Ind. 

An adequate nutrition and feeding program is an important contribution 
to the health and safety program for the employees. — Craig Cochrane, man- 
ager, Industrial Relations Department, Eastman Kodak Co., Rochester, N. Y. 

We are meeting the need for changing food habits necessary under war- 
time rationing by serving more raw vegetable salads, more fresh vegetables 
and fruit, and milk, and weekly Meat Conservation Lunches in our 7 cafe- 
terias and 85 mobile units which provide meals that follow Government 
recommendations. — John C. Becker, cafeteria manager, Curtiss Wright Plant, 
Paterson, N. J. 



16 



INDUSTRIAL NURSE AND WOMAN WORKER 



— The use of supplementary “snacks” between meals is believed to 
decrease fatigue, bolster morale, and increase production. An experi- 
ment (30) made on a group of women operators in a plant manufac- 
turing rubber footwear showed an increase of about 10 percent in 
their production when the women changed from three to five meals a 
day. The amount of food eaten was not increased, but the intervals 
between meals were shortened. It is important that when such be- 
tween-meal refreshments are made available they should be such as to 
have positive nutritional value — milk, citrus-fruit juices, fruits, 
tomato juice, sandwiches, and the like. 

Haggard and Greenberg, who made this study, suggest the possi- 
bility of between-meals use of fruit or tomato juice (31). They point 
out that such juices contain vitamins and minerals, are readily digest- 
ible, and give prompt and definite increase in concentration of sugar 
in the blood. At the same time they are easy to handle in the factory, 
require no preparation, can be quickly consumed, and appeal to a wide 
range of tastes. 

The use of sugar as a source of energy for industrial workers should 
not be encouraged, but rather the use of foods which have more essential 
food factors and a more prolonged effect (32). 

— The lunch period should be sufficient to allow time for going to 
and from the cafeteria, washing the hands, eating without gulping, and 
to leave a few minutes for relaxation. A minimum of 30 minutes is 
necessary in spite of the fact that many plants actually have only 15 
or 20 minutes for lunch. The nurse would do well to discourage the 
workers from eating while they are working or at their workplaces, 
and to encourage the management to supply suitable places and enough 
time for eating lunch. 

That management itself is greatly concerned about this business 
of getting proper food for its workers is indicated in the pamphlet 
published by the National Association of Manufacturers (33), which 
describes the responsibility of management. According to this, lead- 
ership may be taken if management will — 

1. Acquaint itself with the problem in its own plant. 

2. Inform itself about the principles basic to proper diet. 

3. Take five lines of attack : 

a. Educate the worker. 

b. Educate his family. 

c. Provide nutritious food in the plant. 

d. Cooperate with local restaurant owners to provide nutritious foods 

under sanitary conditions. 

e. Make nutritious foods available at low cost. 

Personal hygiene. 

Cleanliness . — To get clean and keep clean is no small achievement 
in many of today’s industrial jobs. But personal cleanliness is one of 
the largest factors in dealing with some of the ills to which workers 
fall heir. For instance, the complete removal of irritating solvents 
from the hands is the main guard against dermatitis on certain proc- 
esses. And scrupulous cleaning is an absolute must in the protection 
of radium dial painters and others working with radium. Many years 
ago, when industrial poisons and similar dangers were first making 
themselves apparent in growing American industries, there was a 
tendency on the part of some employers to disguise them for fear the 
workers would be reluctant to stay on the job or the plant would acquire 



EVERYDAY GOOD HEALTH HABITS 



17 



a bad reputation. Now industry makes a point of telling workers 
what hazards they may encounter on the job and how to protect 
themselves. 

Here, of course, lies an important part of the nurse’s job. Among 
the women new to industry, especially, the nurse is likely to find many 
who require particularly constant and firm guidance in the matter of 
protecting their persons against exposures to solvents, dust particles, 
fumes, and other sources of industrial disease. They may need to have 
stressed to them the part that careful and regular washing plays in 
protecting their health. Here is a considerable job of education to be 
done, and no one is in a better position to do it than the industrial 
nurse. However, there is no point in urging personal cleanliness unless 
the worker has a chance to practice it. The question of adequate 
washing facilities in the plant will be discussed in the next part of the 
report. (See p. 23.) 

One thing that should be made clear to the workers is the possibility 
of carrying into their homes the dangers they encounter on the job. 
Dust or solvents on the clothes may contaminate the home. A woman 
who leaves a scaling gun or a filing bench to go home and cook dinner 
for her husband and children should make very sure that she leaves the 
dust and the metal behind her, too. 

Care of the feet . — The “foot problem” is more serious for women 
than for men. Standing for long hours is very fatiguing to women 
and they may be susceptible to varicose veins. A report of 1,000 
cases seen in a foot clinic states that there were 15 women to every 
man. Of these women, 33 percent had abnormalities of the forefoot, 
and 20 percent had flat feet. About one-third had severe corns, in- 
growing nails, arthritis, or other such conditions. Many of those 
with forefoot deformities were under 30 years of age. 

Lack of exercise, long periods of standing, and inadequate diet con- 
tribute to the problem. But a part of it arises from the habit of 
following unhealthy footw T ear fashions. High heels, narrow toes, 
absence of arch support, and thin soles add up to foot trouble. When 
unsuitable shoes are worn into the factory, where they are especially 
dangerous, the problem becomes serious. 

When jobs require constant standing, rest periods should be al- 
lowed and seats be provided for the women. Very often jobs that are 
done standing could just as well be done while sitting; in such cases 
women should be allowed to alternate their positions. If this can- 
not be done, an attempt should be made to rotate the women on stand- 
ing and sitting jobs, so as to afford some relief to all of them. Women 
who have foot ailments should be shown the need for proper medical 
care. Correctional exercises and treatment should be encouraged 
when they are needed. 

One of the most important jobs of the industrial nurse is, of course, 
to sell the women the idea that broken-down party shoes, loose sandals, 
or other types of unsuitable shoes must not be worn in the factory. 
The appeal to the sense of fitness of proper types of shoes, as well as 
their comfort and safety, can be made a strong one. Moreover, the 
nurse can point out that sturdy and sensible shoes are especially advis- 
able when rationing limits sharply the number that can be bought. 

A safety program in the plant that insists on proper shoes — safety 
shoes when they are needed — is of major importance. The medical 



18 



INDUSTRIAL NURSE AND WOMAN WORKER 



director of a plant employing many women tells the story of one wom- 
an who was wearing a pair of old high-heeled party shoes in the 
plant. She lost both heels coming down some stairs, fell, and sat 
down so violently that her coccyx was broken. This incident was the 
focus of a safety-shoe campaign in the plant; the guilty shoes were 
paraded around on a truck, and from then on, low-heeled oxfords 
were the only working shoes allowed in the factory. It is not the 
part of wisdom, however, to wait until such things happen before 
dealing with an obvious danger. 

Care of the teeth . — It has been stated (34) that many of the ab- 
sences due to nonoccupational illness can be traced to bad mouth con- 
ditions. Thus it is very important, from the standpoint of produc- 
tion as well as that of health, to encourage adequate care of the teeth. 
At the time of beginning her employment, it would be well if the new 
worker could have her teeth examined and be told how much and what 
kind of attention they need. With the proper encouragement and 
follow-up, teeth can be repaired before they cause much damage and 
add to the alread}^ great sum of days lost because of illness. 

In addition to the ordinary run of dental needs are the dangers 
caused by specific hazardous exposures. It is known that such sub- 
stances as lead, mercury, phosphorus, and radium may have a far- 
reaching and destructive effect on the mouth, teeth, and gums. A 
chart prepared by Dr. Isaac Schour and Dr. Bernard G. Sarnat (35) 
shows the types of destruction caused by certain substances, and lists 
occupations that may be considered hazardous for this reason. Thus 
the importance of taking note of the slightest sign of injury or decay 
of gums or teeth should be made clear to workers exposed to such 
special dangers. And all workers, regardless of occupational risks, 
should learn to know the close relation between good teeth and good 
health. This means knowing it with conviction, so that they will 
act on the basis of their knowledge. 

Care of the eyes . — The amount of eyestrain and the need for accu- 
rate vision involved on the job vary from one occupation to another. 
But certainly the well-being of the worker and efficiency on the job 
necessitate good vision and freedom from strain. Tests of eyes 
should be made that are suitable to the job. Thus, inspection work 
involving close visual examination will make certain demands on the 
eyes ; operating a crane or driving a truck will make other demands. 

The worker should be told when he is in need of corrective lenses, 
and urged to get them. If safety goggles are required, proper cor- 
rective lenses should be put in the goggles. 

The Division of Labor Standards of the United States Department 
of Labor, through the National Committee for the Conservation of 
Manpower in War Industries, has instituted an important eye-saving 
program for industry. Through its regional representatives, lectures 
and demonstrations by a specialist in eye-protection are brought to the 
plants. Information about this program can be obtained from the 
Division of Labor Standards. It should be called to the attention of 
plant management by the nurse, if it is not already known. Advan- 
tage should be taken of this opportunity to develop an effective pro- 
gram of education on eye protection for both supervisory personnel 
and the workers. 

The Division of Industrial Hygiene of the Public Health Service 
points out (36) the need to be concerned not only with protective 



EVERYDAY GOOD HEALTH HABITS 



19 



equipment and safety practices to guard eyes from injury on the job, 
but also with the development of standards for visual requirements 
in different types of occupation. Along with such standards must go 
examination of workers’ eyes to determine what their condition is and 
to correct defects. The importance of interest and cooperation on the 
part of workers as well as management is great; and the industrial 
nurse can help to educate the worker to recognize the need for such 
a program. 

Health in the home. 

Of every 10 absences from work due to illness, 9 are due to causes 
not related to the work itself — illness such as everyone, regardless of 
his job, may be subject to. Consequently, it is not possible for the 
medical department to separate sharply the causes of illness and say 
that it will concern itself only with causes picked up on the job. Just 
as a worker may carry infection or disease from the plant to the home, 
so she may carry it in the other direction. Moreover, whatever the 
source, an absence is still a drain on the worker and a hindrance to 
production. 

The woman who works all day on the job and runs her household 
as well needs all the help she can get to keep the health standard 
in her home high enough to protect her and her family from illness. 
Some plants have established a policy of home visits by nurses when 
workers are absent through illness. Others avail themselves of the 
help of visiting nurses from Public Health or other organizations. 
In either case a nurse going into the home will have an opportunity to 
assist directly with the health problems she may find there. If she 
does not visit the home, she must get from talking with the worker 
an understanding of what her home health problems are. 

For more specific help the women can be directed to the medical, 
dental, and health clinics in their communities, to social agencies, to 
child-care centers or other groups organized to take care of local war 
emergency community problems, and to Government agencies such as 
the Public Health Department. 

If there are women counselors in the plant, it should be their func- 
tion to explore these possible outside services and to direct the women 
to them as needed. If there are no women counselors, the Personnel 
Department probably will be in a position to supply such informa- 
tion. In addition, there are in many areas nurses’ organizations that 
can be of assistance in helping the women in the plant. (See pt. V 
for further discussion of this question.) 

Mental hygiene. 

On an earlier page it was mentioned that fatigue can develop from 
mental as well as physical causes; that the relation to her fellow- 
workers, her supervisor, and her environment has much to do with a 
woman’s ability to produce efficiently. The reason for this lies in the 
fact, pointed out by Dr. Lydia G. Giberson (37), psychiatrist in the 
medical division of the Metropolitan Life Insurance Co., that — 

* * * the worker, regardless of mass effort or organization, will in- 

evitably remain an individual and maintain his right to the dignity of an 
individual. * * * The individual is the man who counts. 



20 



INDUSTRIAL NURSE AND WOMAN WORKER 



Added to the task of adjusting to a wartime work program is that 
of facing the practical difficulties at home and in the community. The 
working woman struggles against problems of food, transportation, 
housing and service shortages. This, for the many thousands of 
inexperienced women now in industry for the first time, comes on 
top of the difficulties of a strange and demanding work environment. 

Add again the personal and individual problems each person faces, 
and the fact that there are many workers who have considerable diffi- 
culty in dealing with them unaided. The sum total is, for some 
workers, tension and uncertainty that make them unable to keep going 
without costly effort. At this point, understanding and friendly 
counsel can be of immeasurable help. Some individuals may come 
near enough to the breaking point to need medical advice. When this 
need is apparent, the nurse should be able to discuss with the worker 
what kind of advice she needs, and show her where to get it. Others, 
with a chance to talk out their troubles and get some advice, will find 
themselves able to handle their problems. The nurse’s place in this 
process of adjustment can be a very important one, if she sees and re- 
sponds to the needs that will be shown. And as Dr. Sappington 
points out (38) — 

* * * morale has definite relationships to other important parts of 

ap industrial health program, such as proper nutrition, fatigue control, ai\d 
adequate and properly spaced recreation. No people can be expected i 
maintain top morale who are poorly nourished, who are tired and beset with 
physical and mental ills, and who do not have a reasonable chance to recover 
and recuperate through proper food, adequate rest, and simple recreative 
facilities. 



IV. HEALTH AND SAFETY ON THE JOB 



Responsibility for guarding the health and safety of women workers 
on the job belongs to many people in the plant : The production super- 
visors, the personnel department, the medical department, the safety 
department, and the workers themselves. The nurse can help the 
newcomer to understand the importance of this problem, and whether 
the specific factors involved are or are not her responsibility, she can 
recognize and point out their effects. 

Instruction in health and safety should be a part of the induction 
training that is essential to the successful employment of inexperienced 
women. How much of this instruction falls to the nurse depends con- 
siderably on the size and the organization of the plant. This question 
will be discussed later. First must be examined some of the major 
factors involved, and how they come into the nurse’s range of action. 

HEALTH PROBLEMS IN THE PLANT 

General health factors that carry over into the job. 

The common cold . — A factor} 7 is as good a place as any in which 
to spread colds. Dr. W. M. Gafafer, in his outstanding long-term 
study of illness in industry (39), has indicated the great extent to 
which respiratory diseases contribute to sickness absenteeism. That 
colds do contribute considerably to sickness absenteeism is shown also 
by a number of other surveys. In one such study (40), a study in 
1933 of over a million insured persons in England and Wales, there 
were tabulated 77,180 illnesses among men and 48,406 among women; 
of these, 23.5 percent and 23.8 percent, respectively. w T ere due to colds, 
bronchitis, tonsillitis, and similar ailments. A third study (41), in 
Scotland in 1934-35, showed 8.8 percent of total illnesses among men 
and 12.4 percent among women to be due to colds, coughs, and ton- 
sillitis. A further study of 5,500 persons over a period of 5 years (42) 
showed that among the men 32.9 percent, and among the women 42 per- 
cent, of all lost time due to illness was caused by colds, influenza, and 
tonsillitis. These figures indicate that women are somewhat more 
subject to such illnesses than men, and perhaps need more guidance 
in protecting themselves. 

Thus it is important to watch for the signs of colds, and especially 
for the conditions within the factory that bring them on. Among 
other things, proper clothing is certainly a health factor, and one that 
women, more than men, are likely to disregard. Clothing must not 
only be safe, in that it does not offer hazards around machinery; it 
must be suitable to the weather and the working conditions. Working 
in a hot room, or in a cold one, or moving about from one to the other, 
demands suitable protective clothing. 



593702 °— 44 



21 



22 



INDUSTRIAL NURSE AND WOMAN WORKER 



If the nurse sees that the women are coming in for treatment for 
colds, she should find out if they are exposed to drafts, or are in poorly 
ventilated workrooms. One of the most effective ways of persuading 
management that action should be taken to improve such conditions 
is to show that these conditions are resulting in poor health and 
absenteeism. 

Good food . — Part III explained the importance of the right kinds 
of food and of proper food services in the plant. If there is evidence 
that the women are failing to get the nourishment they need, it may 
be either that the means for getting it are inadequate or that the women 
have not become convinced that they do need it. The nurse may find 
that a better educational program seemed called for on the subject of 
food ; or that those responsible for the cafeteria and other food services 
must be urged to make good food available. 

Service facilities . — Both the health and the morale of workers are 
affected by the surroundings in which they work. The rest rooms 
and washing and toilet facilities available to women can play an 
important part in maintaining their good health and good spirits. It 
is obvious that with the great increase in the industrial employment of 
women there is need also to increase the provision of such services 
for them. 

There are differences of opinion among employers about the use of 
rest rooms by women. In some plants no cots are provided. A 
matron may be stationed not only to keep the place clean but to act 
as policewoman in preventing loitering. Some plants have only 
toilets and washrooms for women, and no place in which they may 
rest. In others, it is a policy to allow women to lie down for a short 
time if necessary, and a suitable room with cots is provided. In still 
others, women are permitted to go to the dispensary or hospital if 
they must lie down. 

Just what arrangements are best depends on the plant, its size, 
the number of women, the types of work they do, the size and arrange- 
ment of the dispensary, and so on. But it is a short-sighted policy to 
have no re5t room for women workers. Very frequently a few minutes 
or half an hour of rest is all a woman needs to get her through the* 
day’s work without sacrifice of health or efficiency ; and thus in many 
instances a day’s absence is prevented. 

The use of the dispensary or hospital cots for brief rest periods does 
not always prove desirable. Many plants with only first-aid stations 
or a small dispensary have no quiet room separated from the room in 
which injuries are dressed. In large plants the dispensary may be so 
far removed from many of the work stations that the women would 
have to take a 10-minute walk for the sake of a 10-minute rest. 

It is important, therefore, that suitably located rest rooms and cots 
be provided ; that these be kept clean ; and that the women be permitted 
to use them as needed. Standards for space and cots in such rest rooms 
as approved by the American Standards Association may be take" 
as a guide ( 43 ) : 

Retiring and Dressing Rooms for Women 

{&) Where 10 or more women are employed at any one time, at least one 
retiring room for their exclusive use shall be provided. 

(b) Where less than 10 women are employed and a retiring room is not 
furnished, some equivalent space shall be provided which can be properly 
screened and made suitable for the use of women employees. 



HEALTH AND SAFETY ON THE JOB 



23 



(c) The minimum space provided for a retiring room for 10 women shall 
be 60 square feet. The minimum increased space for more shall he at least 
2 square feet for each additional woman employed. 

( d ) At least one couch or bed shall be provided in every place where more 
than 10 women are employed. The number of such beds or couches required 
shall be as follows: 10 to 100 women, one bed; 100 to 250 women, two beds; 
and one additional bed for each additional 250 women employed. 

( e ) Every dressing room shall be provided with separate clothes hook 
for every female employee. 

Washrooms and toilet rooms must be adequate in number, well kept, 
and conveniently located. On the basis of field investigations the 
Women’s Bureau recommends the ratio of 1 toilet seat to every 15 
women employed (44). Standards for washing facilities as approved 
by the American Standards Association (43, Rule 3-15) provide for 
at least 1 lavatory, with adequate water supply, for every 10 workers 
up to 100 persons, and 1 for each additional 15 persons. They also 
recommend that for workers exposed to skin contamination by poison- 
ous, infectious or irritating material, 1 lavatory with hot and cold 
water from the same faucet should be provided for every 5 persons. 
Twenty-four inches of sink with individual faucet is considered equal 
to one basin. 

The responsibility for these facilities varies with the administrative 
and maintenance organization of plants. Though the plant nurse may 
not be responsible for them, she is responsible for seeing that the health 
of the workers is not endangered by lack of sanitary equipment or by 
inconvenience of its use. No matter who is in charge of these rooms, 
the nurse is able to use her position in relation to the plant’s health 
program to see that they are adequate. 

Health factors having to do with the job itself. 

Physical strains . — A good deal has been said and written about the 
amount a woman should lift and how she should do it. Books and 
articles have discussed it. States have passed laws saying how 
much a woman may lift — amounts varying from 15 to 75 pounds. 
The Women’s Bureau bulletin on this subject (45) indicates that 
carrying too heavy burdens, or carrying incorrectly, may have seri- 
ous effects on the physical structure of women. Excessive lifting 
may aggravate menstrual difficulties. Deformities may develop that 
will cause trouble at childbirth. The effects of pregnancy, such as 
changes in respiration, pulse rate, composition of the blood, are 
likely to make a woman especially subject to injury by lifting during 
this period. 

There are two ways in which the nurse can help to protect the 
women against strain from lifting. One is to teach them the proper 
way to lift. Often this subject is mentioned in a safety lecture, and 
a demonstration may even be made to show the difference between 
right and wrong lifting. But the women themselves must practice 
enough to get the feel of right and wrong lifting; otherwise it is 
likely to be merely a discussion without much meaning. The time 
is well spent in making sure that each woman understands both the 
technique of correct lifting and the consequences of bad lifting. 

The second way is to see that excessive demands are not made with 
respect to the amount to be lifted. No arbitrary standard can be 
set for all women; those who are strong and muscular may be able 



24 



INDUSTRIAL NURSE AND WOMAN WORKER 



to lift as much as the average man, or more. Others find their limit 
in a much lighter weight. Further, the circumstances of lifting and 
carrying — how often, how far, whether up or down stairs, lifting 
from the floor or from a bench, lifting above the head — all these 
will affect the capacity of the lifter. 

A woman may iiave to push a barrow or hand truck filled with 
material. She may pile lumber or sort scrap or load trucks, all jobs 
that may involve the handling of relatively heavy material. They 
involve also posture and changes of posture that may cause strain 
to the abdominal or the back or other muscles. When women on 
such jobs complain of physical strain, the nurse can help them by 
determining what the strain is, what causes it, how it can be re- 
moved. Or, if the women prove physically unequal to the jobs, 
she can help to get them removed to others more suitable. 

Another possible source of health injury to be watched for is the 
use of pneumatic tools, such as pneumatic drills, air grinders, Sand- 
ers, power wirebrush es, and riveting, scaling, or chipping guns. 
These vary considerably in weight, from small, very light imple- 
ments to tools weighing up to 18 or 20 pounds. Naturally, the effects 
of the heavy tools are likely to be more serious than those of the 
light ones. The two main kinds of hazard they offer arise from 
the way in which the tools are held, and from the vibration experi- 
enced by the operator. Injuries arising from the former cause are 
more likely to occur in inexperienced workers, who are unfamiliar 
with the right way to hold the tool. 

Injuries occur also, though very infrequently, to the joints, espe- 
cially to the elbow of the arm holding the tool. Such injuries are 
thought to be due to the repeated shocks directly transmitted to this 
joint from the tool. Further injuries which may be especially serious 
to women may occur if the tool is held against the chest or the thigh. 

Relatively little is known as yet about the extent to which women 
particularly are affected by the use of pneumatic tools. There is 
some indication that pelvic disturbances are aggravated ? especially if 
the tools are heavy. There has also been some indication (46) that 
already existing menstrual irregularities may be heightened by the 
use of even light riveting guns; though the evidence relates to a 
small number of women and is not wholly conclusive. In some ship- 
yards where women have been employed on chipping, which involves 
using heavy guns requiring great strength just to hold them properly 
in place, they have had to give it up. Scaling guns are used more 
extensively by women. Since they chip rust and paint from metal 
surfaces, and do not dig into the metal itself, their action is somewhat 
less violent than that of the heavy chipping guns. 

Other possible sources of injury are noise and dust. The bad 
effects of these hazards, not peculiar to the users of pneumatic tools, 
should be watched for in anyone exposed to them. 

Perhaps the most important safeguard with respect to the use of 
pneumatic tools by women is to select the right women for the job. 
This selection, together with proper adjustment of the job, will help 
to remove much of the hazard. In the opinion of a number of in- 
dustrial hygienists who have studied the problem, certain recommen- 
dations should be considered when women are assigned to this kind 
of work. These are presented here. 



HEALTH AND SAFETY ON THE JOB 25 

Women with the following characteristics are best suited for work of this 
kind : 

Above average in stature and muscular development. 

The phlegmatic rather than the nervous type. 

Having a history of normal menstrual periods. 

Women with a history or clinical diagnosis of pelvic disorder, especially 
pelvic congestion, should not use vibratory equipment, even of the rotary 
type. 

Pneumatic apparatus should not be used by pregnant women, by women who 
have had repeated pregnancies or abdominal operations, or by women 
with unusually large breasts. 

Adjustments should be made in size and weight of tools for use by women. 
Women should not use heavy pneumatic equipment. 

A sitting posture is preferable to an upright position. 

If standing is necessary, rest periods in the prone or knee-chest position 
are recommended. 

On periodic examination, women showing vasomotor disturbances, nervous 
or arthritic changes, should be transferred to other work. 

Consideration should be given to change of job from time to time. 

Counterbalancing, suspending, or propping tools should be done wherever 
possible to relieve operator of weight and vibration. 

Women should not brace tools such as rivet guns against the chest. It is 
believed that following such practice might aggravate a tendency to de- 
velop cancer of the breast. 

If the work involves production of silica-containing dusts, techniques for 
completely controlling them should be employed. This holds, of course, 

for all workers, men find women. 

Posture . — In Part II the relation between poor posture and fatigue 
was discussed. As with lifting and carrying weights, the women 
should be taught how to relieve the strain of poor posture. Talks, 
simple demonstrations, and perhaps charts should be used to bring 
the point home. 

It should be remembered that standing generally is hard on women 
in any case, and that constant sitting or standing may intensify 
existing menstrual troubles. When women are pregnant it is even 
more important that their jobs do not involve continuous standing. 

The tools and the lay-out of the job . — Most machines used in in- 
dustry were built for men. There are relatively few places in which 
the machines have been especially designed for use by women. Many 
of them are equally usable by both sexes; but there are others whose 
design does not fit structurally with the physical design of women. 
Perhaps the levers are too high for the shorter arm-stretch of most 
women. Perhaps the distance from floor to table is too great, and 
this may mean that a woman will have to stretch her leg constantly to 
manipulate a foot -pedal. Handles are made for a man-size grip, 
and women find them hard to hold on to, and harder to grip. 

The results of such discrepancies may in some cases be strain and 
fatigue. The nurse is likely to encounter them in sickness absenteeism 
or the inability of women to perform their job. One industrial hy- 
giene authority (47) has pointed out that — 

* * * a foot-pedal operator who has to strain unduly to reach the pedal 

may suffer from pelvic congestion with resulting harm to pelvic organs. 

Such causes can be discovered as the nurse talks to the women, or as she 
explores the situations in which they do their work. For example, 
women welders have experienced some difficulty in manipulating the 
welding tongs; and there are now on the market tongs built narrower 
and longer than the usual ones to make the woman’s grip more sure 
and at the same time to give the necessary leverage. Many other tech- 



26 



INDUSTRIAL NURSE AND WOMAN WORKER 



niques have been used, such as installing mechanical lifting and hold- 
ing devices, extension levers, and conveyors. Though these practical 
questions concern the safety engineer and plant management, the nurse 
perhaps best of all can observe the effects of the strains that may arise 
from physical working conditions that are not adjusted to the women’s 
build. It has often been found that such strains can be relieved by rela- 
tively simple devices and a little thoughtful planning. 

Special health problems of women. 

In discussing the physiological problems of women in relation to 
their work in industry, it is of the greatest importance neither to over- 
estimate nor to underestimate them. On the one hand, unnecessary 
limitations may be set on the usefulness of women workers and on their 
opportunities for employment and advancement. On the other, definite 
harm may be done to a woman worker by allowing her to work under 
conditions or on jobs that are highly unsuitable for her. A fair atti- 
tude supported by sound medical advice will prove most productive 
and most satisfactory in dealing with the question. 

Throughout industry there is a grept deal of variety in the method of 
handling these questions. Policies range from completely ignoring 
them to setting up rigid regulations. It is important, therefore, to 
know exactly how much of an issue should be made of the various 
physiological matters that seem to affect the employment of women. 
This means trying to discover how much difference they actually 
make. With her particular relationship to the women workers, the 
nurse is in a position to find out part of the answer, at least, and to 
help to remove some of the difficulties that may be very real obstacles 
in the way of satisfactory employment of women. 

A basic prerequisite for the protection of women, and also for plac- 
ing them on jobs for which they are physically suited, is a good pre- 
placement physical examination. Any defects that might limit a 
woman’s ability to perform certain jobs should be discovered; and if 
they can be corrected, she should be urged to have that done for her 
own sake. Limitations in physical strength should be known before 
a woman is assigned to a job that might tax her beyond her abilities. 
At the same time, great care must be taken not to exclude a woman 
from work she is able to perform. The physical examination should 
be used solely as a technique for helping to determine the worker’s 
highest physical qualifications and assigning her to the job they fit best. 

Menstruation . — One of the reasons why some employers have been 
reluctant to employ women is that they anticipated periodic disability 
due to menstruation. This has been a matter of concern because of 
the desirability of maintaining the work efficiency of the women, and 
the possibility of injury to their health through the work they are given 
to do. 

Two things should be remembered in considering this problem: 
First, that the discomfort that sometimes accompanies menstruation 
comes regardless of whether women work or not, and second, that 
there are industries that have for decades employed women, and these 
workers have remained steadily and productively on the job. 

It may be true, however, that certain operations are generally harm- 
ful for women because they contribute to menstrual discomfort or dis- 
turbances, and that other operations are injurious only to some women. 
Earlier in this discussion, for example, the possible danger of using 



HEALTH AND SAFETY ON THE JOB 



27 



pneumatic tools was mentioned. It is therefore desirable to separate 
two questions that are likely to be confused : To what extent does the 
work affect a woman’s menstrual function? and to what extent is she 
subject to menstrual pain regardless of the job? 

It sometimes happens that a woman who has not had any difficulty 
will begin to experience it when she starts on a factory job. After a 
history of regular and painless periods, they may become irregular, too 
frequent, longer or shorter than normal, or unnatural in other ways. 
Because the physiological function is closely related to emotional 
states, such conditions are often brought on by the tension, nervousness, 
and initial strain that rise from the new and strange conditions of the 
job. When the worker becomes acclimated, the tension eases off, she is 
more sure of herself and more at home, and the irregularities of 
menstruation may disappear. 

Though menstruation is not, in itself, an industrial problem, it is 
true that women do lose time from work because of it. It is also 
true that in many plants certain simple steps have been taken that ap- 
pear to relieve the discomfort and thereby reduce absenteeism. 
Therefore it is advisable for the nurse to find out how much menstrual 
troubles seem to affect the working efficiency of the women in the plant, 
and to consider the following remedies: 

The desirability of having cots in a quiet room where women 
can lie down for a brief period has been mentioned. This op- 
portunity for relaxation is especially important for some women 
during the menstrual period, and has been found to contribute 
greatly toward a saving of time and efficiency in work. 

Some physicians recommend the application of a heat pad or 
the use of an infra-red heat lamp to relieve dysmenorrhea, and 
sometimes they give simple medication. These steps should of 
course be taken only under the instruction of the physician ; but 
they have been found to be helpful. 

The use of physical exercises for the relief of dysmenorrhea is 
recommended by some physicians. These exercises, which are 
very simple, are designed mainly to correct posture defects that 
contribute to menstrual pain because of pressure on pelvic organs. 
A number of prolonged experiments with them have indicated a 
noticeable diminution of dysmenorrhea, and have been followed 
by lowered absenteeism rates from this cause. Sources of infor- 
mation about such exercises are listed at the end of this pamphlet. 
They should be used, of course, only under the guidance of the 
physician. 

Perhaps the most useful thing that can be done to diminish this 
problem, and one that the plant nurse can do better than anyone else, 
is to establish a wise attitude toward it on the part of the women them- 
selves. Physicians state repeatedly that much of the discomfort of 
menstruation is psychological, and stems from faulty health educa- 
tion. If this periodic process can be seen by the women as a normal 
healthy function and not as an affliction, it will be almost certain to 
cause them less distress. The fact is that a great many women do see 
it in this light, and many others can be persuaded to do the same. 

A maternity policy in industry . — The question of the employment 
of pregnant women in industry concerns a relatively small proportion 
of women workers. But the problem appears to be of some moment 



28 



INDUSTRIAL NURSE AND WOMAN WORKER 



to employers at this time, for several reasons. The majority of work- 
ing women are in the child-bearing years ; because of the war many 
married women are working who otherwise would not be; and the 
inexperience of some employers with women workers causes them a bit 
of panic in the face of possibilities that they scarcely know how to 
handle. 

To establish a maternity policy that will protect both the plant and 
the worker is not difficult. It can be done with mutual understanding ; 
and the nurse can perform an important service in creating this mutual 
understanding. For one thing, it should be remembered that most 
women work because they have to ; and that many times a woman who 
is a prospective mother may especially need to work. For this reason, 
employment should be made possible for her as long as she can work 
without injury to herself or her child. 

Moreover, many physicians say that work, if it is not excessive in 
hours and does not involve exposure to hazards, usually is good rather 
than bad, at least during part of the pregnancy period. Dr. H. Close 
Hesseltine, speaking of the recommendations of the Committee on the 
Health of Women in Industry of the Section on Obstetric%^cuJjft^e- 
cology of the American Medical Association (48), says — 

So far, there is no available data which would indicate that ordinary em- 
ployment is detrimental * u e early pregnant state in normal women. 

\T* 

It is the usual practice in plants not to hire women who are known 
to be pregnant; and it is almost equally common to discharge them 
as soon as pregnancy is discovered (49). Such a policy, however, 
encourages women to conceal their pregnancy as long as possible. 
Under such circumstances a woman may continue to work at a job 
or in a place that offers considerable hazard to her health and safety, 
and may make her a hazard to the people with whom she works. 
Moreover, the first three months of pregnancy, which are the most 
easily concealed, are also more precarious than the next three months. 
At this early date, then, women particularly need protection; but 
unless there is a policy in the plant that will encourage them to report 
their condition, they cannot avail themselves of protection. The 
plant also will profit from knowledge of the women’s condition by 
assuring itself that women will be kept on suitable jobs and thus 
experienced workers will not be lost, and by being protected against 
the risk of accident among women doing heavy or hazardous work 
at a time when they are not fitted to do it. 

Standards for such a maternity policy have been recomemended in a 
pamphlet published by the Women’s Bureau and the Children’s Bureau 
of the United States Department of Labor, listed at the end of this 
bulletin and available on request. It indicates the points that should 
be considered : The importance of judging each case individually ; the 
time at which a woman should stop work before the birth of her child, 
and how soon afterward she may return to work; the types of jobs 
that should be avoided because of danger of physical strain or injury 
from toxic substances; the preservation of seniority rights, the oppor- 
tunity to return to her job, the length of hours and rest periods, and 
other conditions of work. 

One point perhaps should be emphasized. The transfer of a woman 
from a hazardous to a nonhazardous job is one way of enabling her 
to continue work during part of pregnancy, and of preventing the 



HEALTH AND SAFETY ON THE JOB 



29 



loss to the plant of a trained worker. Such transfer must be made 
in accordance with plant policy, and on the advice of the physician 
who understands what the jobs entail and what the woman’s physical 
condition allows. Otherwise, transfer is likely to depend on the will 
of the woman’s immediate supervisor and be subject to a natural 
reluctance on his part to disturb his work set-up. 

Throughout the process of establishing and using a good maternity 
policy, the nurse’s role is central. From her personal knowledge of 
the women she can watch for cases that need attention. In her rela- 
tionship with them she can encourage them to ask for and use the 
advice of their own and the plant physician, and can point out to them 
the importance of modifying their work program to fit the needs of 
the coming child. In her position within the administrative organiza- 
tion the nurse can urge on management the wisdom and the necessity 
of such a policy, and because her work in the plant is often more con- 
tinuous than that of the physician she will be able to inform him of 
the cases that appear to need his attention. 

One further point in relation to this subject should be mentioned. 
This is the fairly widespread rumor that women who do arc welding 
may for that reason become sterile. Medical evidence does not bear 
out this possibility. In answer to an inquiry on the subject, the 
National Institute of Health of the United States Public Health 
Service (50) points out that the main exposures in arc welding are 
to ultraviolet rays, ozone, oxides of nitrogen, and heat. None of 
these hazards will give rise to sexual impotence as the sole effect. 
A number of diseases, occupational or other, such as lead or benzene 
poisoning, typhoid or pneumonia, may result in a temporary diminu- 
tion of sexual capacity; but this is believed not to arise in the absence 
of other characteristic features of the specific disease. Further, ex- 
periments to determine whether the light from arc welding gives off 
injurious rays, such as X-rays, have produced no evidence of any 
light-waves shorter than the ultraviolet in the arc. The best medical 
evidence indicates that radiation from arc welding cannot in itself 
produce injury to or destruction of the sexual organs. 

The menopause . — The increase in the number of older women in 
industry has brought up the question of the menopause as affecting 
production. This, like menstruation, is not an industrial problem, and 
should be dealt with, if necessary, by the woman and her private 
physician. It too, however, may impress itself on industry bv causing 
loss of time from the job and perhaps by a lessening of work efficiency. 
Therefore it is something that the plant nurse should be aware of if it 
arises among the women workers. 

In general, physicians have pointed out that if there are no abnor- 
mal symptoms, such as would require medical attention, and no 
menopausal psychosis, the menopause is not a factor that needs be 
considered in the employment of women. When a woman is strug- 
gling with such disturbances, however, and finds difficulty in coping 
with her day-bv-day problems, a considerate and understanding atti- 
tude can help her. Some physicians have suggested a change to light 
work requiring not much concentration or physical effort if the woman 
has been on a heavy or difficult job. 

The attitude of the woman toward the menopause probably is a 
major factor in determining how she will continue her usual activities. 



30 



INDUSTRIAL NURSE AND WOMAN WORKER 



She should be helped to see it as an ordinary and normal process, and 
not as a break-down in her capacity for normal living. 

In this, as in all matters relating to the health of the women workers, 
the nurse’s greatest assistance to them may be summarized in two 
things: First, by her own interest and understanding building con- 
fidence in the medical department, so that the women will go for help 
when they need it; and second, by knowing the specific conditions in 
the plant that may help or hinder good health standards, and urging 
on those responsible the improvement of conditions that alfect the 
health of the workers adversely. 

Occupational diseases. 

The danger of exposing workers to diseases arising from their work 
has always been serious in some industries. With the war, a number 
of factors have made it even more serious. One is the introduction 
of new materials, chemicals, or processes into a plant without time 
to discover first whether they carry with them any unknown hazards. 
Another is the great expansion of plants and of employment, which 
has taxed the safety facilities in industry, often beyond their capacity. 
A third factor is the inexperience of many new workers, who must 
learn to recognize the possible hazards of their jobs before they can 
be protected adequately against them. 

The subject of occupational disease in industry is as complicated as 
the problem of fatigue and is highly technical. Even to define the 
term “occupational disease” is not easy. Does it refer exclusively to 
a disease for which a particular process is responsible, such as lead 
poisoning that comes from the use of lead in glazing pottery, for 
example, or does it cover also diseases arising indirectly from ex- 
posures, as a pneumonia resulting from working in cold, damp 
weather? There has been in recent years a tendency to widen the 
concept of occupational disease to include all diseases suffered as a 
consequence of work, whether directly or indirectly brought on. This 
tendency is shown in various State workmen’s compensation laws, 
which are coming more and more to extend their coverage. 

This report will not attempt to list the occupational diseases, nor 
to discuss their nature, their symptoms, or their effects on the worker. 
It is intended only to point out the fact that women are exposed to a 
variety of hazards of occupational disease, and that there are certain 
places where the industrial nurse should look for evidence of such 
hazards. From making felt hats to welding ships, the list of jobs 
is paralleled by a list of hazards. Of course, many of these hazards 
are adequately guarded against by plant engineering, good house- 
keeping, and personal protective equipment. And in many occupa- 
tions they do not arise at all. However, the nurse should find out for 
herself, or from the medical officer and from the safety director, which 
of them exist in the work that women are doing in* the plant. The 
Division of Labor Standards of the IT. S. Department of Labor has 
issued an excellent guide (51) to occupational hazards, which is of 
great help to the nurse in identifying the effects of specific exposures. 
J. J. Bloomfield, of the Industrial Hygience Division of the United 
States Public Health Service, has pointed out (52) how the nurse 
can make a practical survey of occupations in her plant that might 
give rise to occupational diseases. If she keeps a record of such 



HEALTH AND SAFETY ON THE JOB 



31 



occupations by plant department, she has a quick reference to possible 
causes for illness when women come into the dispensary. Sample 
forms issued by the Public Plealth Service, on which such records can 
be kept, and which can be adapted to the plant’s needs, are obtainable 
from the Government Printing Office or from the local agencies offer- 
ing nursing consultant services. These agencies are listed at the end 
of this pamphlet. 

What are the kinds of diseases that attack workers through their 
jobs? The majority of them, it has been found, are of two types: 
Industrial poisonings and dermatoses (53). In addition (54), there 
are diseases arising from the following causes: 

Abnormalities of air pressure, temperature, and humidity. 

Dampness. 

Defective illumination. 

Dust. 

Infection. 

Radiant energy. 

Repeated motion, pressure, shock, etc. 

There are a number of published statements naming the various 
occupational diseases that arise from these causes. They give also 
information on how much exposure constitutes a hazard ; the symptoms 
of the diseases, how frequently they occur in certain industries, what 
the consequences are to the workers, and how protection may be 
achieved. References to some of these sources are given at the end of 
this pamphlet. ,„* T . 

Which of the causes mentioned above furnish a hazard to the work- 
ers with whom a nurse is concerned is something that she can find out 
only by knowing her own plant. When the women come to her for 
help, she should know not only what work they do but the conditions 
under which they work. Witv.^^ect to possible poisoning, for 
example, the nurse should find out whether the women have been 
working with lead, mercury, benzol, or other substances that might 
produce symptoms of poisoning; whether they have been exposed to 
dust, fumes, or vapors that might harm them. 

It should be remembered that working with such materials does not 
in itself constitute a hazard. If protection is adequate, the worker is 
safe. And responsibility for determining whether this is the case 
obviously rests with the safety experts. The importance to the nurse 
of knowing the facts about the conditions of work in the plant is that 
when a woman becomes ill some such hazard may be a source of the 
illness. The nurse’s knowledge of the possible existence of the hazard 
may help to bring about a quicker cure and to prevent a recurrence. 

Poisonous substances may be introduced into the body through 
inhaling, through the skin, or by way of mouth. Inhaling dusts, 
fumes, vapors, or gases is the most common way in which workers are 
poisoned. Sometimes workers handle dangerous materials and then 
handle food without washing their hands, or eat at their workbench 
and so ingest poisons with their food by way of mouth. Provision of 
proper washing facilities should be an invariable rule for such workers, 
perhaps supplemented by a prohibition against eating at the work- 
bench. In some occupations, such as handling radium, inhalation is 
particularly dangerous; but carrying poisonous substances to the 
mouth through lack of careful washing of hands may also constitute 



32 



INDUSTRIAL NURSE AND WOMAN WORKER 



a hazard. Workers should be convinced of the importance of avoiding 
such practices. 

One of the most helpful factors in protecting the women is to tell 
them what hazards exist in their jobs and how to guard against them. 
Further, they should be reminded frequently of their responsibility 
for being careful. The importance of safe work habits must be 
emphasized until they become second nature. 

There has been much discussion about whether women are more 
susceptible than men to certain poisons. This is a question on which 
doctors themselves do not always agree. It is held by some, for 
instance, that women are more susceptible to lead and benzol poisoning 
than men are, and that in the case of lead they are more subject to the 
extreme type of poisoning that attacks the nervous system and the 
brain. Whether or not this is true, the important thing is to remove 
the hazard, so that no one, whether man or woman, will be exposed 
to it at all, to any harmful degree. The whole trend in present 
industrial safety practice is to do just this — to remove the source of 
danger rather than try to give individual protection to the person 
exposed to it. 

Many women are in jobs that involve the use of oils, grease, and 
cleaning solvents. They may be running a lathe, which uses a 
coolant; they may be packing parts, first dipping them in a protec- 
tive oil; they may be cleaning metals preparatory to painting or 
polishing. Such operations often get the hands into liquids that 
have a seriously irritating effect on the skin, sometimes developing 
one or another type of rash. Outbreaks of dermatitis are among 
the most common cases of occupational disease. Frequently they 
are not lasting in their effects, but even so they cause discomfort, 
pain, and loss of time from work. There are a number of protective 
lotions and creams designed to furnish protection of the skin against 
irritants. Which type is most effective will depend on the agent 
causing the trouble and on the particular susceptibility of the work- 
er’s skin, and these matters should be determined by the physician 
who knows these factors as well as the chemical nature of the pro- 
tective substance. 

Individuals vary considerably in their susceptibility to dermatitis, 
according to the texture of their skin, their pigmentation, and other 
factors. Nurses do well to watch for those women who are most sub- 
ject to this disease, and to have them transferred to other occupations 
in which they are not exposed to it. 

Much is being done to remove irritants from oils, lubricants, and 
solvents used in industry. But authorities on dermatoses make it 
clear that one of the most effective protections lies in exercising the 
greatest care in matters of personal hygiene. The women exposed to 
skin irritants should be convinced that careful hand-washing to re- 
move such elements is absolutely essential as protection against 
dermatitis. 

At the same time it should be remembered that in some instances a 
harsh soap does more harm than cutting oils. For this reason the 
soap supplied in the washrooms should be carefully chosen, and this 
is an item that the nurse can help to control. The medical officer will 
know what soaps are best for the purpose, and the nurse will know 
whether the women are finding the soap supplied irritating to their 
skins. 



HEALTH AND SAFETY ON THE JOB 



33 



Sometimes hazards arise out of the conditions of work, rather than 
the exposure to certain substances. Do the women work out-of-doors 
in bad weather, or alternate between a heated room and the cold? Do 
they work in excessive heat, or dampness, or in poorly lighted or 
poorly ventilated rooms? These also are questions the answers to 
which will help the nurse to understand the ailments of women who 
need the help of the medical department. 

SAFETY ON THE JOB 

Within the past two decades the function of a safety program in 
industry has expanded greatly. Such programs are recognized as 
preventive measures; both worker and employer are concerned to 
prevent accidents. Safety is recognized as an integral part of plant 
operation ; it is built into the plant and is related to all the operations 
and to all the conditions of work. The extent to which this is true 
varies, of course, from plant to plant. Some plants have as yet devel- 
oped very little safety-awareness, whereas others have well established 
programs of accident prevention. 

The responsibility for such programs rests, primarily, on the safety 
department. But everyone in the plant bears some of it. The nurse 
can contribute a large share toward building safety by recognizing 
and reporting the points at which special attention is needed, and by 
helping to develop safety mindedness in the workers. The importance 
of the nurse in this field is indicated by the fact that nurses are be- 
coming increasingly interested in safety training. Safety training 
courses are being offered under the sponsorship of the United States 
Department of Labor and the United States Office of Education. In 
a number of cities industrial nurses are taking these courses, and .find 
them effective in giving the basic facts about safety which the nurses 
need. 

The need to be aware of safety problems. 

Every new worker is a possible source of danger, to himself and to 
others, until he learns the elements of safety on the job. This is 
especially true of some of the women now coming into war plants, 
who have never had any association with factory conditions and have 
never been exposed to the kinds of hazards they present. Their com- 
plete lack of industrial experience and their general unfamiliarity 
with tools and machinery make it especially important in their in- 
troduction to the factory to stress safety. They must acquire a safety- 
awareness that can only be brought about by special effort on the 
part of those responsible for inducting them into the job. 

This safety-awareness cannot be attained from a few minutes’ talk 
on safety when the women first come on the job. It is the result of 
continued education. And the nurse is in a very strong position to 
help in this education. The women come to her when they are injured, 
or at other times when they are psychologically ready to listen to 
what is told them about safety. 

The kinds of accidents that women have. 

A woman working on an unguarded press had a finger cut off. 
After the accident, guards were placed on all the machines. 



34 



INDUSTRIAL NURSE AND WOMAN WORKER 



A woman got up to leave her machine. Walking across the floor 
she tripped over a chair and broke her arm. 

A laborer climbed on a box to reach some material. The box 
tumbled, she also tumbled. The accident cost her 2 days of working 
time. 

A packer unloading and lifting boxes sprained her back so severely 
as to keep her at home for a week. 

Another laborer standing on a box that tumbled over received 
injuries to head, shoulder, and pelvic bone. 

The operator of a lapping machine had some hair pulled out when 
it got caught in the machine. 

A girl hurrying to her work across a parking lot fell and sprained 
an ankle. 

A laborer fell over the tongue of a truck, suffering a fracture that 
disabled her for 54 days. 

A woman operating an overhead electric crane in a shipyard 
climbed down the ladder from the cabin to the floor. The ladder had 
no rail. She was wearing “wedgies” — shoes with no heels. She 
slipped ; her shoe could not catch on the rung because it had no heel ; 
there was no hand-rail to grab. She fell to the floor and broke her 
arm. 

A man working near the ceiling of an electric plant dropped a pipe. 
It struck a woman below, disabled her for over three weeks, and 
caused the loss of use of one finger. 

On her first day at work a munitions handler in an ordnance depot 
was helping another woman to control the movement of 500-pound 
bombs down a conveyor. She decided that the bombs were moving 
too fast, and tried to slow them by putting her foot up against one 
of the crates containing the bombs. Her foot caught between the 
moving crate and the conveyor, and she fell off the platform. She 
lost 7 days of work. 

The question why women have such accidents is complicated, but 
it must be asked if accidents are to be prevented. Obviously, many 
factors are involved. Some of these factors are personal, such as 
wearing improper clothing, doing things in a reckless way, being 
unskilled in handling the job or ignorant of its dangers, reluctance 
to follow safety rules, and so on. The munitions handler had been 
working less than a day; she might well be expected not to under- 
stand the ways of conveyors. With proper safety instruction new 
workers can learn what to look out for, and before they acquire that 
knowledge they can learn to be on their guard. 

The accident to the crane operator was a combination of faulty cloth- 
ing and faulty working conditions. If the ladder had been railed, and 
if she had had heels to her shoes, the likelihood of her falling would 
have been much less. And though she might be unable to do any- 
thing about the railing, she should have been instructed to wear the 
right kind of shoes and should have worn them. 

Climbing on a pile of boxes, instead of on a set of steps or a ladder, 
is a good example of poor safety habits. So is working around moving 
machinery with unprotected hair, as the lapping-machine operator 
did. Other factors have to do with the working environment, such 
as the situation of the workman who dropped the pipe on a woman 
below ; or the machine that was unguarded until someone lost a finger 



HEALTH AND SAFETY ON THE JOB 



35 



on it; or the crane ladder without a railing. All these factors involve 
the need for responsibility on the part of management, first for setting 
up safe conditions in the shop, and then for safety education of the 
workers. 

It must not be forgotten that many accidents, even those inside the 
plant, are not related to the specific work the women are doing. One 
of the most common types of accident to women is falling — falling on 
the street, on stairs, while walking through the factory. This fact 
is indicated by the report of temporarily disabling injuries for which 
women received workmen’s compensation in Pennsylvania in 1911 (55). 

Power machinery, such as drill presses, punch presses, sewing ma- 
chines, accounted for about 21 percent of these injuries, or just over 
one in five. One in four were listed under “working surfaces,” and 
four-fifths of these were injuries caused by floors and stairs — stumb- 
ling, tripping, falling. It seems clear from this that women have a 
safety problem in addition to that brought on by the machine or oper- 
ation itself. Education is the only answer, education and training, 
which the nurse can help to secure for them. 

As increased numbers of women are taken into industry, their age 
range necessarily broadens. More young girls and more older women 
are employed. The same Pennsylvania report shows that between 1939 
and 1941 the number of girls 21 years of age and younger increased 
by almost 15 percent. The number between the ages of 22 and 40 
was practically unchanged; and those over 40 increased by over 
26 percent. These are changes in the numbers of women who had 
injuries on the job that disabled them for more than a week. The 
increasing number of accidents to women reflects, of course, the in- 
crease in their employment ; there are more women exposed to the pos- 
sibility of industrial accident. These figures, though including only 
statistics for the State of Pennsylvania, show the trend that is indi- 
cated throughout the country. 

Because of the increased employment of women of all ages, it is to 
be expected that the proportion of industrial accidents that occur to 
women also will increase. This is supported by figures issued by the 
Industrial Commission of Wisconsin (56’). Of all injuries reported to 
this commission, the proportions that were injuries to women rose be- 
tween 1939 and 1943 as follows : 



1939 . 

1940 . 

1941 . 

1942 . 

1943 . 



Percent 
__ 6.8 
__ 7.1 
__ 6.8 
9.3 
14 . 0 



Even within the year 1943, an increase from quarter to quarter is 
noticeable. Percentages for the four successive quarters of 1943 were : 
11.8, 13.2, 15.0, and 16.0, giving an average of 14.0 percent. This in- 
crease in accidents to women means chiefly, of course, that more women 
are employed. But it is also to be expected that they will do more and 
more of the hazardous jobs from which at first they were largely pro- 
tected ; and this will be an additional source of increased injury. That 
is why everything that can be done by the nurse to combat the injuries 
and illnesses of the women in the plant is of great value, not only to 
them but to the achievement of the fullest and most efficient production 
in the plant. 



36 INDUSTRIAL NURSE AND WOMAN WORKER 

Helping the women to be safe. 

Much that has been said on earlier pages about health problems can 
also be said about safety. In both instances the two strong bulwarks 
are, first, the acceptance by management of responsibility for good 
health and safety programs ; and second, the education of workers to 
assume, in turn, their share of responsibility. The nurse can help in 
both these aspects: First, by calling to the attention of the proper 
authorities the information she can get from the women and from her 
own observation; and second, by taking an active part in educating 
the workers for health and safety. With respect to the safety problem 
itself, here are some of the points at which the nurse can be of use. 

Safety clothing . — For most women clothes have always been a 
subject of intense interest; and generally women have come to accept 
certain traditional ideas about style and function of dress. Now more 
than ever new ideas are intruding themselves into this customary 
way of thinking. One of these ideas is safety . Hundreds of thousands 
of women are coming to judge their work clothing by whether or not it 
is safe to work in. This idea, new to so many women, takes some time 
to be firmly rooted ; and though they are learning, they may need to 
be urged and persuaded to bring into practical use this notion of the 
special suitability of their clothing for their work. 

Standards for work clothing have been described in the Women’s 
Bureau Special Bulletin 3, Safety Clothing for Women in Industry, 
and detailed requirements have been established by the American 
Standards Association (see references). Private industry, the Army, 
and the Navy have all set up standards for the women who work in 
their factories, arsenals, shipyards, and other places. It is not neces- 
sary to describe here what the specific requirements are. But the 
nurse can see whether the clothes the women wear to work meet the 
safety standards of the plant. Further, if the plant does not have such 
standards, or if there is no rigorous application of them, she can urge 
that they be made an important part of a safety program. She can 
also talk to the women about the need for this, pointing out the specific 
places at which they risk injury through unsafe clothing. Sweaters 
or other loose garments, unsuitable and uncomfortable shoes, jewelry, 
flowing hair — these are the most obvious sources of injury. 

Hazardous jobs . — Some women can undertake jobs with a certain 
physical risk better than other women can. Some are better at climb- 
ing; or they are stronger and can lift weights more constantly; or 
they can undertake relatively heavy clean-up jobs. Physical stamina 
is a requirement of a number of jobs in which women are employed, 
and those who are without it where it is needed are likely to suffer 
accidents. Other types of hazard require steady nerves and a calm 
disposition — as, for example, the handling of explosive materials or 
some of the pneumatic tools. 

The placement of the right woman on the right job is, of course, 
the work not of the nurse but of the personnel department. But the 
final test of whether this is done lies in what happens on the job. 
The nurse is often in a better position than others — even than the 
foreman — to know when a woman is doing something that is beyond 
her power to do safely. In such circumstances the nurse should be 
able and ready to urge the transfer of women from the work they 



HEALTH AND SAFETY ON THE JOB 



37 



are doing to something more suitable for them. If she knows what 
the jobs are, and the health and strength of the women who are doing 
them, and if she knows them understandingly, she can be of great 
assistance in pointing out assignments of work that carry with them 
special risks to the safety of the individual and perhaps of those 
working with her. 

An open eye for bad spots . — In plants that are well supplied with 
safety inspectors or safety committees, hazardous working conditions 
generally are found out promptly. In departments in which fore- 
men and other supervisors are well trained in the principles of safety, 
such conditions do not escape discovery. But in plants without a 
rigorously enforced safety program, or lacking trained personnel, 
there is a need for vigilance on the part of everyone. The nurse 
can contribute her share of this vigilance as she walks through the 
plant, keeping her eyes open for hazards that often are obvious but 
ignored. Safety manuals list them in detail. Among them rre the 
effects of poor housekeeping such as crowded or narrow aisles, poorly 
placed materials, irregular floors that offer a tripping hazard, danger- 
ously loaded trucks, dark passageways or corners, broken or un- 
guarded stairs, inadequate or glaring lights. There are, of course, 
many others; but these are the ones most apparent on casual observa- 
tion. Other dangers may be discovered from a study of the accident 
records in the dispensary or first-aid room, in many plants the study 
of these records is an essential part of the safety program; in others, 
they are used very little except in determining whether a person is 
fit to go back to work or in coses involving workmen’s compensation. 
By reporting to management her own observations of any suspect 
conditions throughout the plant, and by making use of or urging the 
analysis of the records she keeps, a nurse can contribute greatly to the 
safety of the workers and to the efficiency of the plant. 



V. TAKING PART IN A HEALTH AND SAFETY 
PROGRAM IN THE PLANT 

Earlier sections of this bulletin have pointed out some of the spe- 
cific problems that women workers face as they come into the plant, 
and ways in which the industrial nurse can help them to solve these 
problems. They deal wuth both the personal and the plant factors 
that contribute to good or bad health on and off the job; safety prac- 
tices and the understanding of hazards; special physical or psycho- 
logical characteristics that may affect the performance and continued 
efficiency of women. 

A good many of these are matters that come up in the ordinary 
course of the nurse’s contact with workers, as indicated earlier. It 
is important for the nurse to pick up whatever casual references to 
them a woman may make when she goes to the dispensary for some 
other reason. It is even more important to recognize these problems 
as contributing to the difficulties a woman may be struggling under 
though she does not speak of them. She may not realize their effect, 
or may be reluctant to bring them up. If the nurse knows what 
the circumstances of the work and environment are, and recognizes 
the possibility of health difficulties, she is often able to clear up the 
obvious trouble. 

Even such enlightened observation on her part, however, is not 
sufficient. Unless plant management recognizes the importance of 
this service and builds a planned program for health and safety, the 
nurse’s efforts are likely to have only sporadic and limited effect. 
Where such a program exists, her job should be incorporated into it. 
Where it does not, she needs to convince management of its im- 
portance in the attainment of a high standard of work performance 
and efficiency. 

This part of the report is not intended to describe the total program 
that might be developed, which may differ widely from plant to plant. 
Many factors determine its form, in addition to the all-important one 
of management’s interest. Among these factors are: Size of plant; 
kind of equipment; nature of work; existence of hazards; size and 
organization of medical department; organization of other depart- 
ments, such as safety, training, and personnel; and relation between 
departments. 

How much the nurse will be called on or be able to do, with respect 
to the program of the plant, will depend largely on these factors. A 
few of the more important points at which she can contribute may be 
indicated here : 

1. In an earlier section of the report emphasis was put on the in- 
duction period as the time for introducing safety and health care to 
the new workers, especially to the women industrially inexperienced. 
It was pointed out that giving specific facts about the hazards in- 
volved on the job and the way of guarding against them must be an 

38 



TAKING PART IN A HEALTH AND SAFETY PROGRAM 



39 



important part of the induction program. These hazards are not only 
the conditions inherent in the job, such as weight-lifting, exposure to 
poisonous substances, or the operation of machinery. They include — 
though “hazards” may be too strong a word — the ordinary daily events 
that may develop health or safety difficulties on the job: Colds, lack 
of proper food or sleep, discomfort due to unsuitable clothing, the 
strangeness of the sights and sounds and smells of a factory, the awk- 
wardness of handling new tools and going through new motions, un- 
familiarity with the types of relationship set up in a shop. To* ac- 
quaint the incoming woman with such of these factors as constitute 
health matters, and to show her how the nurse can help her to deal 
with them, is an important part in the induction program. The ex- 
tent to which the woman is prepared for her job will have a good deal 
to do with how quickly and satisfactorily — to herself and to her em- 
ployer — she can become integrated into the plant life. 

Such work should be followed up in the day-to-day contacts with 
the women. Some of the ways in which this can be done are listed in 
the paragraphs following. 

2. The knowledge gained by the nurse of plant conditions that need 
attention should be passed on to responsible management officials. 
This is especially necessary where there is no safety department or 
person specifically responsible for ferreting out unsafe or unhealthy 
conditions. It is necessary when, in their visits to the medical de- 
partment, workers show signs of illness or injury arising from unsus- 
pected sources — hitherto unexposed plant hazards. 

The same thing can be said when the nurse has evidence that women 
are on jobs for which they are not physically suited, or which put an 
undue burden on their health and energy. She should be able to sug- 
gest transfers for health reasons when they seem necessary. 

It is obvious that the working-out of this activity will vary with the 
structure of the medical department. If there is a physician only 
on call or only on part time, more of the responsibility for such action 
will fall on the nurse than if there is a full-time physician in the plant. 
Even in the latter case it will often happen that the nurse can learn 
directly from the workers their need for such aid. They will not 
always go to the physician for help ; they may not be aware that they 
need it. Such cases can be brought to the physician’s attention by the 
nurse, so that he can investigate more fully the condition of the w T orker 
and follow up with whatever action is appropriate. 

3. In plants having a planned safety-and-health program, the 
nurse’s understanding of and relationship with the women can be very 
helpful in dealing with problems calling for the cooperation of many 
departments and the working together of people with various func- 
tions, such as medical, safety, personnel, supervision, and training. 
Problems that arise in any of these fields very frequently have bearing 
on the others, and in order to integrate policy and action, conferences 
and discussions among the various people should be held. In such 
discussions the nurse can contribute to the understanding of the others 
the knowledge she has gained in her own field, and can show the 
workers’ need for help on specific questions. It is important, for in- 
stance, for the safety engineer to know whether women find equipment 
difficult to manipulate for reasons of physical strength or size. The 
foreman should know which women in his department are especially 



40 



INDUSTRIAL NURSE AND WOMAN WORKER 



susceptible to dermatitis from a solvent used in some operation, so that 
he will assign less sensitive workers to that particular job. The per- 
sonnel director should know that a general rundown condition is re- 
sponsible for consistent absenteeism on the part of certain workers. 
Seldom are any of the factors affecting the health or efficiency of 
workers isolated from all other factors. Usually they are a combina- 
tion of health, safety, supervision, and personnel, or at least of some 
of these. A free exchange of information about problems among 
those concerned with these various aspects of the plant functioning 
is necessary if fullest use is to be made of the special skills of each. 

4. It is important to know the community resources in matters of 
health, in order to be able to refer the women to them as need arises. 
One of the most useful sources of aid and information is the industrial 
nursing consultant in the industrial hygiene division of the local de- 
partment of public health or department of labor. About half the 
States have such service; and in the others the nurse can turn to the 
local medical association or nurses’ organization to find out what can 
be done to aid the women in cases of specific health needs that go 
beyond the responsibilities of the plant medical department. 

The appended list of industrial nursing consultants (p. 42) shows 
in which States such service is available. These consultants will dis- 
cuss with industrial nurses the plant and the home-nursing problems 
that the women workers face, and will help either in dealing with them 
at the plant, if that is where they should be dealt with, or in finding 
the proper nursing, medical, or clinical help in the community for 
problems outside the jurisdiction of the plant medical department. 

Other community agencies that it is important to know are the 
child-care, social welfare, and recreation services. The need to refer 
women to these services will, of course, vary considerably. Some of 
the factors that will determine this are: The kind of community in 
which the plant is situated, the relation of the plant to the community, 
and whether the women have recently come into the region to fill a' 
labor need or are residents of long standing. 

If there is a woman counselor in the plant, she will of course be, 
the person to establish such community contacts for the women workers 
and advise them where they may receive help on their home problems. 
But where no woman counselor exists, the nurse is the logical person 
for the women to consult. 

5. One of the ways in which the nurse can aid most fully in the 
plant-wide program is to encourage and take part in the various edu- 
cational activities. Among these the following should be mentioned : 

Health committees . — Safety committees made up in whole or in 
part of the workers are becoming more widely recognized as important 
in plant programs. Their value is twofold : First, they are extremely 
useful in creating and holding the interest of the workers in questions 
of safety ; second, they give to plant management the benefit of the 
workers’ ideas. Since the problems of safety closely concern the 
workers, because they are the ones who suffer when accident or illness 
occurs, their contribution to establishing a good record of safe practices 
can be considerable. 

Health committees similar to such safety committees should be es- 
tablished. Because health problems in the plant are primarily the 
concern of the nurse, she can advocate and help to develop these com- 



TAKING PART IN A HEALTH AND SAFETY PROGRAM 



<41 



mittees and encourage the workers to participate in them. Women as 
well as men should be urged to take part in the work of the health 
committees. Women who have had no industrial experience will find 
this an excellent way of learning about the problems involved and 
what their own responsibility is. They also may be better able than 
men to bring out and to help in the solution of those health problems 
that most closely concern themselves. 

Management, if not already agreed, should be induced to see the 
advantages of health committees as a technique for improving both 
the plant conditions and the workers’ understanding of their own 
place in creating and keeping a high standard of health in the plant. 

The plant paper . — A good medium for health propaganda is the 
plant paper. Articles on health, nutrition, safety, recreation, and 
exercise can keep these matters in the minds of the readers. Special 
series addressed to women workers can give information on the par- 
ticular matters they are concerned with, such as food preparation, 
care of children, appropriate work clothing, and available community 
services for health and recreation. The nurse can supply many of 
the facts and ideas that go into such articles, or write them herself. 
Coming from her in her professional capacity, they probably would 
have special weight with the women who read them. 

Leaflets , posters, pamphlets, and films . — References at the end of 
this study (p. 46) give sources for printed material in the form of 
leaflets and pamphlets carefully prepared to meet the needs of workers. 
Leaflets on food, for example, are designed to be easily read and to 
contain suggestions and recipes that are simple to follow. It is very 
important not to overburden the women, already beset by many re- 
sponsibilities, with material which they have not the time, nor the 
energy, nor the interest, to use. But this material is not a burden, 
it is a time-saver. 

Posters emphasizing simple health facts should be displayed on 
well-stationed bulletin boards. When safety or health committees are 
dealing with special problems over a period of time — a drive for the 
use of goggles, say, or care of colds, or eating well-balanced meals — 
posters covering these special subjects will add strength to the drive 
and will bring to the fore ideas to which workers are at the time 
particularly susceptible. 

These are matters for which the nurse certainly will not be wholly 
responsible, but she can undertake to see that authentic health infor- 
mation is available and to bring out the information that deals spe- 
cifically with the health problems confronting the workers in her 
particular plant. And if there is no one else with the drive and fore- 
sight to carry out such an educational program, it will amply repay 
effort on the nurse’s part in terms of increased health-mindedness on 
the part of the workers. 



State, County, and City Agencies That Offer Industrial Nursing 

Consultant Services 

[As of May 1944] 



California Bureau of Industrial Health, California 

Dept, of Public Health, 2002 Acton St., 
Berkeley 2, Calif. 

Los Angeles County Division of Industrial Hygiene, Los An- 

geles County Health Dept., 808 N. 
Spring St., Los Angeles 12, Calif. 

Los Angeles City Division of Industrial Hygiene, Los An- 

geles City Dept, of Health, 116 Temple 
St., Los Angeles 12, Calif. 

Connecticut Bureau of Industrial Hygiene, Connecti- 

cut Dept, of Health, Hartford 1, Conn. 

Georgia Industrial Hygiene Service, Division of 

Preventable Diseases, Georgia Dept, of 
Public Health, Atlanta 3, Ga. 

Illinois Division of Industrial Hygiene, Illinois 

Dept, of Public Health, 1800 W. Fill- 
more St., Chicago 12, 111. 

Indiana Bureau of Industrial Hygiene, Indiana 

Board of Health, 1098 W. Michigan 
St., Indianapolis 7, Ind. 

Iowa Division of Public Health, Engineering 

and Industrial Hygiene, Iowa Dept, of 
Health, Des Moines 19, Iowa. 

Kansas Division of Industrial Hygiene, Kansas 

Board of Health, 812 National Reserve 
Bldg., Topeka, Kans. 

Massachusetts Division of Occupational Hygiene, Mas- 

sachusetts Dept, of Labor and Indus- 
tries, 23 Joy St., Boston 14, Mass. 

Michigan Bureau of Industrial Hygiene, Michigan 

Dept, of Health, Lansing 4, Mich. 

Mississippi Division of Industrial Hygiene, Missis- 

sippi Board of Health, Jackson 113, 
Miss. 

Missouri Industrial Hygiene Section, Division of 

Public Health, Engineering and Indus- 
trial Hygiene, Missouri Board of 
Health, Jefferson City, Mo. 

New Hampshire Division of Industrial Hygiene, New 

Hampshire Board of Health, Concord, 
N. H. 

New Jersey Industrial Hygiene Service, New Jersey 

Dept, of Health, 637 Broad St. Bank 
Bldg., Trenton, N. J. 

Newark City Division of Industrial Hygiene, Newark 

City Dept, of Health, Plane and Wil- 
liams Sts., Newark, N. J. 

New York: 

Syracuse City Division of Industrial Hygiene, New 

York Dept, of Labor, 766 Irving Ave., 
Syracuse, N. Y. 

New York City Industrial Hygiene Cooperative Unit, 

New York City Dept, of Health, 12-26 
31st St., Long Island City 2, N. Y. 



42 



TAKING PART IN A HEALTH AND SAFETY PROGRAM 



43 



North Carolina Division of Industrial Hygiene, North 

Carolina Board of Health, Raleigh, 
N. C. 

Ohio Industrial Hygiene Division, Ohio Dept. 

of Health, State Office Bldg., Colum- 
bus, Ohio. 

Cincinnati City Dept, of Health. 

Oregon Division of Industrial Hygiene, Oregon 

Board of Health, 410 Oregon Bldg., 
Portland 4, Oreg. 

South Carolina Division of Industrial Health, South 

Carolina Board of Health, Columbia 10, 
S. C. 

Tennessee Division of Preventable Diseases, Ten- 

nessee Dept, of Public Health, Nash- 
ville 3, Tenn. 

Memphis City Dept, of Health. 

Texas Industrial Hygiene Section, Bureau of 

Sanitary Engineering, Texas Board of 
Health, Austin 14, Tex. 

Utah Division of Industrial Hygiene, Utah 

Board of Health, Salt Lake City 3, 
Utah. 

Vermont Division of Tuberculosis and Industrial 

Hygiene, Vermont Dept, of Public 
Health, Burlington, Vt. 

Washington Division of Industrial Hygiene, Wash- 

ington Dept, of Health, 1412 Smith 
Tower, Seattle 4, Wash. 

West Virginia Bureau of Industrial Hygiene, West Vir- 

ginia Dept, of Health, 1584 Washing- 
ton St., East, Charleston 1, W. Va. 

Wisconsin Industrial Hygiene Unit, Wisconsin 

Board of Health, State Office Bldg., 
Madison 2, Wise. 



SOURCES REFERRED TO IN TEXT 



(1) Hamilton, Alice. Fatigue, in Protecting Plant Manpower, Spec. Bui. 3, 

Division of Labor Standards, U. S. Dept, of Labor, 1941, p. 5. 

(2) Sayers, R. R. Major Studies of Fatigue, m War Medicine, Sept. 1942. 

Amer. Med. Assn., Chicago. 

(3) Lubin, Isador. Statement before Senate Committee on Education and Labor 

and House Committee on Labor, on Wage and Hour Bill, June 1937, p. 347. 
See also Women’s Bureau Spec. Bui. 1, Effective Industrial Use of Women 
in the Defense Program ; and OWI leaflet, Recommendations on Hours of 
Work for Maximum Production, by a committee representing 8 Federal 
agencies. 

(4) Vernon, H. M. Health and Efficiency of Munition Workers. Oxford Uni- 

versity Press, London, 1940, pp. 91-92. 

(5) See Women’s Bureau Spec. Bui. 10, Women’s Effective War Work Requires 

Good Posture. 1943. 

(6) Garner, J. R. Posture and Fatigue, in National Safety News, Feb. 1942, 

p. 38. National Safety Council, Chicago. 

(7) Vernon (see 4), p. 40. 

(8) Mayo, Elton. Human Problems of an Industrial Civilization. Macmillan, 

New York, 1933, pp. 32-34. 

(9) Hamilton (see 1), p. 7. 

(10) Hamilton (see 1), p. 8. 

(11) Luckiesh, M. Seeing and Human Welfare, Williams & Wilkins, 1934, p. 

118, quoted in Industrial Hygiene and Plant Efficiency Through Good 
Lighting, U. S. Dept, of Labor, Division of Labor Standards, 1943, p. 13. 

(12) Division of Labor Standards bulletin just cited (see 11) , p. 14. 

(13) Brandt, Allen D., and Harry E. Seifert, in Manual of Industrial Hygiene, 

U. S. Public Health Service, Notional Institute of Health, 1943, p. 353. 

(14) McCord, C. P., Teal, E. E., and W. N. Witheridge. Noise and Its Effect on 

Human Beings, in Jour. Amer. Med. Assn., May 7, 1938, p. 1553. 

(15) New York Dept, of Labor, Bureau of Women in Industry. Effect of Noise 

on Hearing of Industrial Workers. Spec. Bui. 166. 1930. 

(16) Vernon (see 4), p. 113. 

(17) Brandt and Seifert (see 13), p. 366. 

(18) Mintz, Beatrice. Shift Rotation Problems, in New York State Industrial 

Bulletin, Dec. 1942, p. 423. See also Women’s Bureau Spec. Bui. 6, Night 
Work for Women and Shift Rotation in War Plants. 1942. 

(19) National Research Council, Committee on Work in Industry. Fatigue of 

Workers : Its Relation to Industrial Production. 1941. 

(20) Collier, Howard E. Outlines of Industrial Medical Practice. Edwar<V 

Arnold, London, 1940, p. 177. 

(21) Sappington, C. O. Essentials of Industrial Health. Lippincott, Philadel- 

phia, 1943, p. 137. 

(22) Pritchard. Elizabeth G, in Manual of Industrial Hygiene (see in Brandt, 

13), p. 303. 

(23) Vernon, H. M. Health in Relation to Occupation. Oxford University 

Press, London, 1939, p. 331. 

(24) National Research Council, Committee on Nutrition in Industry. Food and 

Nutrition of Industrial Workers in Wartime. Reprint and Circular 
Series 110, Apr. 1942. 

(25) U. S. Dept, of Agriculture, Office of Distribution. Manual of Industrial 

Nutrition, 1943, p. 17. 

(26) Boudreau, Frank G., quoted in Sappington (see 21), p. 322. 

(27) National Research Council, Committee on Nutrition in Industry (see 24), 

p. 8. 

(28) National Research Council (see 24), p. 2. 

(29) U. S. Dept, of Agriculture, Food Distribution Administration. OWI release 

1651, Apr. 26, 1943. 

44 



SOURCES REFERRED TO IN TEXT 45 



(30) Haggard, H. W., and L. A. Greenberg. Diet and Physical Efficiency. Yale 

University Press, New Haven, 1935, p. 128. 

(31) Haggard, H. W., and L. A. Greenberg. Selection of Foods for Between- 

Meal Feeding in Industry, in Jour, of Amer. Dietetic Assn., Oct. 1941, 
p. 754. 

(32) U. S. Dept, of Agriculture, Office of Distribution (see 25), p. 9. 

(33) National Assn, of Manufacturers. Food, Work and War. New York, 1942, 

p. 13. 

(34) Hooper, H. A. Dental Services in Industry, in Industrial Medicine, Apr. 

1942, Chicago, p. 158. 

(35) Schour, Isaac, and Bernard G. Sarnat. Chart, in Sappington (see 21), 

facing p. 74. 

(36) U. S. Public Plealth Service, National Institute of Health. Industrial 

Hygiene News Letter, March 1944, Yol. 4, No. 3. 

(37) Giberson, Lydia G., in Manual of Industrial Hygiene (see in Brandt, 13), 

p. 292. 

(38) Sappington (see 21), p. 44. 

(39) Gafafer, W. M. Sickness Absenteeism Among Industrial Workers. Third 

Quarter of 1943. U. S. Public Health Reports, Vol. 59, No. 11, March 17, 
1944. See also earlier reports in this series. 

(40) Vernon (see 23), p. 48. 

(41) Vernon (see 23), pp. 49 and 56. 

(42) Smith, May, and Margaret A. Leiper, quoted by Vernon (see 23), p. 56. 

(43) American Standards Assn. Safety Code for Industrial Sanitation in Man- 

ufacturing Establishments, Z 4.1, 1935, Rule 3.17. 

(44) See Women’s Bureau Spec. Bui. 4, Washing and Toilet Facilities for Women 

in Industry. 1942. 

(45) See Women’s Bureau Spec. Bui. 2, Lifting Heavy Weights in Defense Indus- 

tries. 1941. 

(46) Bradbury, W. C., and Charles B. S. Evans. Women in Industry (a study 

of 135 riveters), in Industrial Medicine, Oct. 1943, Chicago, p. 690. 

(47) Kronenberg, Milton H. Women and Wartime Health Problems, in Indus- 

trial Medicine, July 1942, Chicago, p. 334. 

(48) Hesseltine, H. Close, in Ohio State Medical Journal, June 1943, p. 548. 

(49) Sappington, C. O. Health Problems of Women in Industry. Industrial 

Hygiene Foundation Medical Series, Bui VII, Jan. 1944, p. 8. See also 
Silverman, Charlotte. Maternity Policies in Industry, in The Child, 
Aug. 1943, pub. by Children’s Bureau, U. S. Dept, of Labor. 

(50) U. S. Public Health Service, National Institute of Health. Letter dated 

Nov. 28, 1912. 

(51) U. S. Dept, of Labor, Division of Labor Standards, Occupation Hazards 

and Diagnostic Signs, Bui. 41, 1942. (A guide to impairments to be 
looked for in occupations.) 

(52) Bloomfield, J. J. Responsibility of the Nursing Profession in Industrial 

Hygiene. U. S. Public Health Service, Public Health Reports, Washing- 
ton, May 30, 1941. Vol. 56, No. 22, pp. 1131-1141. 

(53) U. S. Public Health Service, Manual of Industrial Hygiene (see in Brandt, 

13), p. 140. 

(54) Dublin, L. I., and R. J. Vane, quoted in Manual of Industrial Hygiene (see 
in Brandt, 13), p. 139. 

(55) Pennsylvania Dept, of Labor and Industry, Bureau of Research and Infor- 

mation. Industrial Injuries in Pennsylvania, 1941, Statistical Supple- 
ment, Part II : All Compensable Cases. 

(56) Wisconsin Industrial Commission. Workmen’s Compensation Statistics. 

Statistical Release 3125, Jan. 13, 1944. 

ADDITIONAL SUGGESTED READINGS 

General. 

American Standards Assn. Specifications for Women’s Industrial Clothing, L 17, 
December 1943. 

Industrial Nursing. Supplement to Industrial Medicine. Published quarterly 
by Industrial Medicine Pub. Co., Chicago. 

Manual on Industrial Health for War Workers. Massachusetts Committee on 
Public Safety, Division of Health and Social Services, Boston, Jan. 1943. 
Selling, Lowell S. A Psychiatrist Looks at Industrial Truancy, in Industrial 
Medicine, Apr. 1943, Chicago, p. 189. 



46 



INDUSTRIAL NURSE AND WOMAN WORKER 



U. S. Dept, of Labor, Women’s Bureau : 

The Women’s Bureau will send on request its complete list of war publi- 
cations, including occupational surveys in various war industries. Single 
copies of special bulletins and all mimeographed material may be obtained 
from the Bureau without charge. Larger numbers of bulletins may be 
ordered from the Superintendent of Documents. Washington 25, D. C., at 
prices listed. 

Lifting Heavy Weights in Defense Industries. Spec. Bui. 2. 1941. 5c. 
Safety Clothing for Women in Industry. Spec. Bui. 3. 1941. 10c. 

Washing and Toilet Facilities for Women in Industry. Spec. Bui. 4. 

1942. 10c. 

Women’s Effective War Work Requires Time for Meals and Rest. Spec. 
Bui. 5. 1942. 5c. 

Women’s Effective War Work Requires Good Posture. Spec. Bui. 10. 

1943. 5c. 

When You Hire Women. Spec. Bui. 14. 1944. 10c. 

The Woman Counselor in War Industries: An Effective Svstem. Spec. 
Bui. 16. 1944. 5c. 

Recreation and Housing for Women War Workers: A Handbook on 
Standards. Bui. 190. 1942. 10c. 

Standards for Maternity Care and Employment of Mothers in Industry. 
1943. Prepared by Children’s Bureau and Women’s Bureau. (Mult.) 

For a general discussion of night-work problems and the conditions 
prevailing in the United States after the First World War see Women's 
Bureau Bui. 64, Employment of Women at Night. 1928. (Out of 
print but available at libraries.) 

An excellent series of 17 posters and an equally good series of 11 pamphlets 
on workers’ health have been issued by the Division of Industrial Hygiene of the 
U. S. Public Health Service and may be obtained on request by writing to that 
division at Bethesda, Md. 

The nurse’s part in a health and safety program. 

American Public Health Assn. Report of Committee to Study t\e Duties of 
Nurses in Industry, in Amer. Jour, of Public Health, July 1943, New York, 
pp. 865-881. 

Bethune, Frances. Safety Is Part of the Nurses’ Job, in Public Health Nursing, 
Apr. 1941, pp. 242-244. National Organization for Public Health Nursing, 
Inc., New York. 

Council on Industrial Health, American Medical Assn. Medical Service in 
Industry, in Jour, of Amer. Med. Assn., March 14, 1942, Chicago, pp. 895-896. 

Standing Orders for Nurses in Industry, in Jour, of Amer. Med. 

Assn., Aug. 28, 1943, Chicago, pp. 1247-1249. 

Johnson, Joanna M. The Nurse in Industry, in Industrial Medicine, June 1943, 
Chicago, pp. 3S6-390. 

Perkins, Elna I. Health Education for Industrial Workers, in Industry, June 
1943, Associated Industries of Massachusetts, Boston, p. 31. 

Fatigue. 

Davis, Hallowell, Portis, Sidney A., Forbes, W. H., and S. Howard Bartley. 
Symposium on Fatigue. Psychosomatic Medicine, April 1943, Vol. 5, No. 2, pp. 
152-165. 

Dill, D. B., Bock, A.V., Edwards, H. T., and P. H. Kennedy. Industrial Fatigue, 
in Jour, of Industrial Hygiene and Toxicology, Sept. 1936, Williams & Wilkins, 
Baltimore, pp. 417-431. 

Ivy, A. C. The Physiology of Work. Proc. 4th Ann. Congress on Industrial 
Health, A. M. A. Council on Industrial Health. January 1942, p. 3. 

National Research Council, Committee on Work in Industry. Fatigue of Workers 
and Its Relation to Industrial Production. Reinhold, New York, 1941. 
Roethlisberger, Fritz J., and Wm. J. Dickson (with collaboration of Harold A. 
Wright). Management and the Worker. Harvard University Press, Cam- 
bridge, 1939, 615 pp. 

Spaeth, Reynold A. The Problem of Fatigue. Jour, of Industrial Hygiene, 
May 1919, Vol. 1. 



ADDITIONAL SUGGESTED READINGS 



47 



Special health problems of women. 

Billig, H. E., Back Pain and Neuritis, in Amer. Jour, of Clinical Medicine, April 

1941, Chicago, pp. 96-99. 

Billig, H. E., Dick, A. C., and (Mrs.) H. N. Macy. Menstrual Exercises, m In- 
dustrial Medicine, Sept. 1943, Chicago, p. 588. 

Burnell, Max It. Gynecological and Obstetrical Problems of the Industrial Physi- 
cian, in Industrial Medicine, March 1944, Chicago, p. 211. 

Council on Industrial Health, American Medical Assn. Recommendations of 
Committee on the Health of Women in Industry, Section on Obstetrics and 
Gynecology, in Jour, of Amer. Med. Assn., March 13, 1943, Chicago, pp. 800-802. 
Metropolitan Life Insurance Co. Hygiene for Working Women. New York. 
13 pp. 

Seward, Georgene H. Psychological Effects of the Menstrual Cycle on Women 
Workers, in Psychological Bulletin, Feb. 1944, Northwestern University, Evan- 
ston, 111., pp. 90-102. 

Nutrition. 

Borsook, Henry. Industrial Nutrition and the National Emergency, in Amer. 
Jour, of Public Health, May 1942, American Public Health Assn., New York, 

1942, pp. 523-525. 

Underwood, Felix J., Ritter, Wayne L., and Mary Stansel. Group Feeding in 
Small Plants, in Industrial Medicine, Feb. 1944, Chicago, p. 160. 

U. S. Dept, of Agriculture, Bureau of Home Economics. Eat the Right Food to 
Help Keep You Fit. 1940. (Folder, prepared with cooperation of several 
Government agencies.) 

War Food Administration, Office of Distribution (formerly Food 

Distribution Administration). Planning Meals for Industrial Workers, 
monthly Industrial Nutrition Service, posters, “Eat a Lunch that Packs a Punch” 
folder, and series of Basic 7 food table tent cards. Washington, 1943. 

The following organizations have issued pamphlets on preparation of meals, home 
food plans, and nutrition education for workers : 

General Electric Co., Schenectady, N. Y. 

Metropolitan Life Insurance Co., Policyholders’ Service Bureau, New York, N. Y. 
Servel, Inc., Evansville, Ind. 

Westinghouse Electric & Manufacturing Co., Mansfield, Ohio.