Genitals:

Phimosis,

Paraphimosis,

Scars,

Ulcers,

Urethritis, orchitis, epididymitis,

Varicocele,

Hydrocele,

Undescended testicle, etc.

Degrees of varicocele:

Limbs:

1st degree-Thickening of cord.

2nd degree-Thickening of cord and dangling testicle and scrotum, with laxity. Angle worm mass.

Contractures,

Ankyloses,

Rheumatic joints,

Tubercular joints,

Amputations,

Deformities,

Hypertrophies,

Atrophies,

Varicosities,

Flat feet.

Degrees of varicosities:

1st degree-Venous mottlings on one or both lower ex

tremities.

2nd degree-Venous cords visible on one or both lower

extremities.

3rd degree-Venous cords visible and palpable on both

lower extremities.

Degrees of flat feet:

1st degree-One or both arches sagging.

2nd degree-One or both arches touch floor.

3rd degree-One or both arches touch floor with eversion deformity.

Nervous System:

Tabes dorsalis,
Multiple sclerosis,

Disease of state probable diagnosis, if any skin lesion.
Scars and marks.

Lymph Nodes:

Cervical,

Inguinal,

Epitrochlear, etc.

Note appearances, whether tubercular, luetic, or pyogenic. The above are suggestive of the defects and abnormalities that the examiner needs to be on the lookout for. The degrees of defects here expressed are according to the standard adopted by the Conference Board of Physicians in Industrial Practice, May 22, 1915.

The routine reexamination of employes, annually or semiannually, is impracticable in a large industry with a big labor turnover. A partial method of physical reexamination is readily achieved by examining (1) disabled members before they return to work, and periodically calling them for reexamination; (2) others, who will be referred by their foremen, or their friends, as in need of health service. This partial method focuses attention on those requiring such service, and eliminates the dissipation of energy incident to reexamining annually thousands of near normal men.

Who should conduct the physical examination? The industrial physician is needed for the study of occupational diseases, and for service as a sanitary inspector-supervision of heat, light, ventilation, as affecting health and efficiency. The industrial physician should teach resuscitation, and the care of the injured; he should proclaim the gospel of good health, and not consume his entire time and energy bandaging fingers, and conducting physical examinations of transient employes. If, under ideal arrangements, the industrial physician would not examine prospective employes, by what agencies could these physical examinations be conducted? Let us digress a moment from the real to the ideal. There are four types of agencies, including the industrial physician, for conducting the physical examination:

(1) The family physicians could conduct such examinations. The family physician already has "too many irons in the fire," unless he devotes a definite quota of his time to industrial work. Industrial medicine has become a new specialty, and the industrial physician can better conduct physical examinations for employes. Specialization has been so far advanced, that the service of a Diagnostic Clinic, wherein representatives of the several specialties in medicine are included, would provide a superior Health Chart. Such a health chart, annually renewed, valid in every state, would be invaluable to the transient worker, who never tarries more than one or two paydays on any job, as well as for the continuous worker, who remains loyally by his employer year after year.

(2) The State Physician. Many of the commonwealths now have State Tuberculosis Dispensaries, from which selected patients are sent to State Sanatoria for treatment. Such state dispensaries could be multiplied in number, and the scope of their staff physicians so increased, that all persons in every commonwealth would be provided with the services of a diagnostic clinic once each year, at an expense not to exceed $2.00 per person per year. A Health Chart, listing all existing physical defects, would be a guide to the employer in fitting the candidate for employment into the right type of work.

(3) The Federal Physician. The army and navy stations. could be multiplied, with physical examination stations in all the hospitals, and additional hospitals erected, where required-thousands of additional physicians could be educated for the federal health service, just as West Point and Annapolis graduate men for the army and navy. With federal Diagnostic Clinics everywhere, an annual physical examination, and an accurate health chart for every citizen, there would be accurate records available for industrial service, as well as for the exigencies of war.

The truth about existing physical defects will injure no one; everybody has, or acquires, certain physical defects. Where correction is possible, these defects should be remedied; the fitting of the physically defective into industry will eventually be achieved, when the state and federal physicians, as well as general practitioners, cooperates with the industrial physicians to this end.

Eyes. The examination of the eyes of children of school age reveals the fact that a large percentage of children have defective eyes. Refraction work should be correct, as improper lenses may prove worse than none at all. Whenever defects of vision are discovered, glasses should be properly adjusted; reexaminations, every year in many cases, are essential, to determine what changes are occurring within the eye. Astigmatism and many other ocular defects are congenital. These visual defects should be discovered in the schools, and corrected as a preparation for industrial life. Properly adjusted lenses will conserve vision, will prevent eyestrain, and the reflex neuroses from eyestrain will enable the patient to do more work and better work with less fatigue. Not only is the production increased, but the incidence of accidents is diminished, when vision is brought up to near normal, and kept there, with correcting lenses. Instances are frequent where men lose fingers on properly safeguarded machines; after the accident, "hind sight" reveals that these men have ocular defects (diplopia, etc.), whereas the foresighted method is to know the defects of vision, and have them corrected, prior to the liability of any such injury.

Some of the industries have placed skilled oculists on their hospital staff. The desirability of this service is unquestionable; employes may not be able to pay the services of a skilled oculist, hence the company is advancing its own interests (as measured in increased production and diminished accident liability) in treating the eyes of employes.

With his advancing years, the average man discovers that the ciliary hypertrophy is lost, which compensated for a moderate degree of astigmatism, or other visual defect. He then imagines. that some minor injury, his hard work, or the lighting system, has been solely responsible for an ocular defect, which he had all his life, but of which he was not cognizant in earlier years. It cements good relations between the employe and employer, for the latter to accept the viewpoint of the former, however erroneous it may be, and furnish him correcting lenses that will conserve his vision, that will relieve the eyestrain, and the fatigue therefrom, and will make of him a more cheerful and a more contented employe.

It is difficult to prove that defective vision always increases accidents. In one instance a man with failing vision, blind in

one eye and having less than 1/40th vision in the other, worked for many years on a bending machine, and had no accidents. There are machines that blind men may safely operate, yet it is not advocated to place blind men on band saws and boring mills. Men with one eye may be safer, because careful; on the other hand, one good eye and the other defective may present an ocular in coordination, such that the employe cannot properly judge distances, thereby increasing the hazard of sustaining personal injury, and coincidently increasing the industrial hazard of injury liability.

Teeth. Children should be taught the use of dental silk and a tooth brush. Some children have never been taught to cleanse their teeth. The hygiene of the mouth is much neglected. Respecting this neglected education in mouth hygiene, under 10% of employes in our factories have cared for their teeth, notwithstanding the fact that the dental profession arose in America.