Industrial health: meeting the challenge.

Abstract

The modern industrial system had its origin in England just over 200 years ago. This period historically is referred to as the Industrial Revolution. It was marked by mechanical inventions in textile machinery, by advances in the manufacture of iron, and by the introduction of steam power. These, in turn, were the foundations of the factory system. In 1784 at a cotton mill at Radcliffe, near Manchester, an epidemic of malignant fever affected the operatives and spread to the surrounding population. The situation became serious and the local justices invited Dr. Thomas Percival, a leading local physician, to investigate the nature and circumstances of the outbreak. With his colleagues and leading citizens he formed the Manchester Board of Health. The Board, through authoritative reports, made recommendations for the control of such epidemics by the establishment of isolation hospitals. They also urged the need for the improvement of environmental conditions in mills and factories and for the diminution of working hours, especially for children and women. In pursuance of these objects the Government in 1802 passed the Health and Morals of Apprentices Act. This was the first Factory Act. Since then factory legislation has been greatly extended and is the basis of statutory supervision of factories and factory workers under the inspector of factories. The development of this supervision is traced with special reference to the work of the certifying surgeons, now the appointed factory doctors, and the medical inspectors. Concurrently, public health education and workmen9s compensation were advanced through legislation. Since 1935 voluntary medical services have been developed in industry. These services have not been restricted to the observance of the minimum standards prescribed by statute and so have been able to pioneer advances directed to the promotion of safety, health, and welfare in factories and other places of employment. Radcliffe, Percival, and steam power are recognized as the growing points of the challenge to health by the Industrial Revolution. The means whereby the challenge was met are discussed. Towards the end of the nineteenth century scientists increasingly concentrated their studies on the elements. This culminated in the isolation of the atom. During the last 10 years atomic power has become a reality and the foundation of the second Industrial Revolution. While the potential hazards of ionizing radiations had long been known and proved at Hiroshima, the inherent dangers for the general population only became impressed on the public mind by a breakdown at the Windscale No. 1 plutonium pile on October 10, 1957. Radio-active iodine escaped, contaminating the atmosphere as far afield as western Europe. A committee under the chairmanship of Sir Alexander Fleck was appointed to investigate the cause of the accident and its consequences and to make recommendations. The report, which laid special emphasis on safety and health, was published early in 1958. So by analogy, Windscale, Fleck, and atomic power are identified as the growing points of the challenge of the Second Industrial Revolution. How this challenge is to be met by doctors is discussed. It is submitted that the urgent need is to formulate now a basic philosophy for future development of industrial medicine. Continuation of the old order will not suffice: ideas must again become revolutionary. The responsibility for leadership rests on the Industrial Health Advisory Committee established in 1955 under the chairmanship of the Minister of Labour and National Service.