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Bulletin 228

Women’s Bureau




of the

(Revision of Special Bulletin No. 19)


For sale by the Superintendent of Documents, U. S. Government Printing Office
Washington 25, D. C. - Price 15 cents


United States Department of Labor,
Women’s Bureau,

Washington, May 16, 1949.
Sir : I have the honor to transmit a report originally prepared in
1944, analyzing the responsibility of the industrial nurse, 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 personal problems that lower women’s
efficiency on the job; and other developments of the war years.
A number of the people using this report have pointed out that the
basic material in it is just as valuable now as it was during wartime
and have suggested that it be revised omitting any reference to war­
time. The report being submitted does not include any new material.
The original report was the work of Jennie Mohr of the Bureau’s
Research Division.
Respectfully submitted.
Frieda S. Milder, Director.
Hon. Maurice J. Tobin,
Secretary of Labor.


Letter of transmittal---------------------------------- ---------------------------------------I.The Women Come to
II. Getting Tired Out



Long hours of work
Home responsibilities
Monotony-------------------------- ------------------------------------------------Physical environment
Noise:---------- ---------------------------------------------------------------Ventilation and heating ----------Night work
Personality factors in fatigue-------------------------------------------------III. Everyday Good Health Habitsj_______________________________
We are what we eat
Eating facilities in the plant
Personal hygiene________________________________
Care of the feet
Care of the teeth
Care of the eyes
Health in the home
Mental hygiene
IV. Health and Safety on the Job-------------------------------------------Health problems in the plant
General health factors that carryover into the job_________
The common cold__________________________
Good food
Service facilities
Health factors having to do withthe job itself_____________
Physical strains
The tools and the lay-out ofthe job._________________
Special health problems of women:_______________________
A maternity policy in industry
The menopause
Occupational diseases
Safety on the job
The need to be aware of safety problems________
The kinds of accidents that women have_________________
Helping the women to be safe-__________________________
Safety clothing
Hazardous jobs:____________________________________
An open eye for bad spots
V.Taking Part in a Health and Safety Program in the Plant____
Health committees
The plant paper
Leaflets, posters, pamphlets, and films
Referred to in Text
Additional Suggested Reading









The Industrial Nurse and the Woman Worker
What can be done by an industrial nurse whose immediate concern
is the health of the workers in the plant? Not only the health of the
women but their performance in the factory depends in a great measure
on what the nurse can do about these women who go to her for help.
She can get at the reasons for their absences or for quitting their
jobs. She, perhaps better than anyone else, can discover from them
conditions within the factory that hamper their production.
This bulletin shows the need for an industrial nurse who is capable
of giving more than first aid—one who has an understanding of
human relations and working conditions.
Many women have had little or no experience with machines and
tools and therefore are unfamiliar with mechanical things and ter­
minology. They find the factory environment strange and have dif­
ficulty in making the adjustment to this new life. The size, noise,
movement, and confusion often are overwhelming. Especially for
the housewife, coming into the factory for the first time, the importance
of such things looms large. She has been accustomed 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.
Therefore, it may be difficult for her in the first weeks of her employ­
ment to adjust to the discipline of paid employment.
Many of the women are married—have homes and children. Fre­
quently they have no relief from their home responsibilities when
they start on a factory job. Consequently they are doing tvTo jobs at
once. On top of a full day’s work in industry they must prepare the
meals, care for the children, do the shopping 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 staying
ability? To what extent should the plant nurse undertake to aid
them in dealing with these questions ?
The introduction of younger women into factories also brings prob­
lems. Many are undertaking their first jobs and have no experience
to guide them. They have no maturity of judgment that might help
them adjust to the environment nor any knowledge of what is to be
expected of them or what they may expect from others.
One of the problems to be considered is the physical capacities and
requirements of women. There are wide differences among women,




but on the average they have 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 physical structure is different ; their muscles, especially of the
feet and legs, are quicker to tire. Therefore, the suitability of equip­
ment that ordinarily is used by men must be considered. Are tools
too large to grasp or too heavy to wield ? All these factors affect the
production of women workers. It is unwise to ignore them—especially
when with understanding and vision they can be improved. The most
obvious place of the industrial nurse is in the medical service of the
plant. Her special concern is 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 problems, or for their rela­
tionships within the plant, or for their difficulties 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.
The work of the industrial nurse is different. The very fact that
she functions 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. Bight 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
will be discussed in some detail later, may have to do with the physi­
cal demands of the job or with the working environment; 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 performance 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
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

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. Rather, 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
1 References in parentheses throughout this report are to “Sources Referred to in Text,’’
p. 45.




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.
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. H. 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-liour 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, rest periods, and


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 is 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. It. 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 puts pressure on the abdominal
organs and may help to bring about displacement of the generative
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 wThich the plant nurse
can contribute to the relief of fatigue of the women workers. It has
been shown that continuous sitting, as well as continuous standing, is
tiring. Many 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.



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.

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 hitter, pessimistic pre*
occupation, and by irregular attention to the work. This attitude was
found to disappear in the majority of cases by tlie 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 fail 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 Yoik
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
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 operation, (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 wTorkers 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
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 (18), 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
job. The scientific study of fatigue made at a Western Electric
Co. plant (19) gives much evidence showing that such factors may
have 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
* * * 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 ind.fferent 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 they
affect their ability to work 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.

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 secu­
rity outside. To the worker, the foresight of this nurse is of enor­
mous value. It protects the worker’s ability to stay on the job, to
produce, and to maintain economic security. It means steady per­
formance and steady wages; less to pay out for curing ills, because
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, better
That this responsibility of the industrial medical department is
commonly recognized is reflected in the words of Dr. C. O. Sappington (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
may be informed concerning his personal health.
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. Y.)
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.
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.
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
significance as greater numbers of women go into industrial work.
One manager of a chemical plant in England found that his women
employees had much higher incidence of gastric complaints than the
men but that this sex difference disappeared after the diets of the
women were improved (24). Dr. Frank G. Boudreau, chairman of
Food and Nutrition Board and Committee on Nutrition in Industry,
National Research Council, points out (25) that there are three ways
in which food deficiency can be dealt with: The first is educationworkers cannot improve their health through proper eating unless thev
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.
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 eating?
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 needed 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. Foods
from each group should be included in the diet each day:

Green and yellow vegetables, raw, cooked, frozen, or canned.
Oranges, tomatoes, grapefruit, or raw cabbage or salad greens.
Potatoes and other vegetables and fruits.
Milk and milk products or cheese.
Meat, poultry, fish, or eggs, or dried beans, peas, nuts, or peanut butter.
Bread, flour, and cereals—natural, whole-grain, enriched, or restored.
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
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 night 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
838300—49------ 3



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. The nurse
can encourage this practice by showing management 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 (2G).
-—The use of supplementary “snacks” between meals is believed to
decrease fatigue, bolster morale, and increase production. An experi­
ment (27) 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 between-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 (28). 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 essen­
tial food factors and a more prolonged effect (29).
—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 neces­
sary. 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
That management itself is greatly concerned about this business of
getting proper food for its workers is indicated in the pamphlet pub­
lished by the National Association of Manufacturers (30), 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 basi'c 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
a bad reputation. Now industry makes a point of telling workers
what hazards they may encounter on the job and how to protect them­
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 ade­



quate washing facilities in the plant will be discussed in the next part
of the report. (Seep. 22.)
One thing that should he 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 unhealthful footwear 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 cannot
be done, an attempt should be made to rotate the women on standing
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.
A safety program in the plant that insists on proper shoes—safety
shoes when they are needed—is of major importance. The medical
director of a plant employing many women tells the story of one
woman 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 (31) 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 already 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 farreaching and destructive effect on the mouth, teeth, and gums. A
chart prepared by Dr. Isaac Schour and Dr. Bernard G. Sarnat (32)
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 Industrial Hygiene of the Public Health Service
points out (33) the need to be concerned not only with protective
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
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 emer­
gency 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. Y
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 fellowworkers, 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 (34), 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.

The working woman struggles against problems of food, transpor­
tation, 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
responds to the needs that will be shown. And as Dr. Sappington
points out (35) —
* * * morale has definite relationships to other important parts of an
industrial health program, such as proper nutrition, fatigue control, and
adequate and properly spaced recreation. No people can be expected to
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

Responsibility for guarding the health and safety of women workers
on the job belongs to many people in the plant: The production super\ isors, 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
ti aining 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.
General health factors that carry over into the job
The common cold.—A factory 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 (36), 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 (37), a study in
1933 of over a million insured persons in England and Wales, there
were tabulated 77,180 illnesses among men and 48,466 among women;
of these, 23.5 percent and 23.8 percent, respectively, were due to colds'
bronchitis, tonsillitis, and similar ailments. A third study (38), 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 (39)
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 sale, 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.
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
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 arrangehient of the dispensary, and so on. But it is a short-sighted policy to
have no rest 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
838300—49------ 4



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 taken
as a guide (40) :
Retiring and Dressing Rooms for Women
(а) Where 10 or more women are employed at any one time, at least one
retiring room for their exclusive use shall he provided.
(б) 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.
(c) The minimum space provided for a retiring room for 10 women shall
be 60 square feet. The minimum increased space for more shall be 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 (41). Standards for washing facilities as approved
by the American Standards Association (43, Buie 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 (42) 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 yray 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
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 have 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, 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 wirebrushes, 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 (43) 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.
Women with the following characteristics are best suited for work of this
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
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.
AVomen 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 and 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 La ve 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 (44) 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
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 rel atively 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
attitude supported by sound medical advice will prove most produc­
tive and most satisfactory in dealing with the question.
Throughout industry there is a great deal of variety in the method
of handling these questions. Policies range from completely ignor­
ing 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
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 wTork 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"
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
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
To establish a maternity policy that will protect both the plant and
the woi'ker 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. II. Close
Hesseltine, speaking of the recommendations of the Committee on the
Health of Women in Industry of the Section on Obstetrics and Gyne­
cology of the American Medical Association (45), says—
So far, there is no available data which would indicate that ordinary em­
ployment is detrimental to the early pregnant state in normal women.

It is the usual practice in plants not to hire women tvlio are known
to be pregnant; and it is almost equally common to discharge them
as soon as pregnancy is discovered (46). 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 recommended 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
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 (47) 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 by 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-by-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.
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 affect 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. 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
taxes the safety facilities in industry, often beyond their capacity.
A third factor is the inexperience of 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 expo­
sures, 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 com­
ing 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
Bureau of Labor Standards of the U. S. Department of Labor has
issued an excellent guide (48) to occupational hazards, which is of
great help to the nurse in identifying the effects of specific exposures.
J. J. Bloomfield, of the Industrial Hygiene Division of the United
States Public Health Service, has pointed out (49) 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



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 Health 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.
What are the kinds of diseases that attack workers through their
jobs? Ihe majority of them, it has been found, are of two types:
Industrial poisonings and dermatoses (50). In addition (51), there
are diseases arising from the following causes:
Abnormalities of air pressure, temperature, and humidity.
Defective illumination.
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.
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. With respect to possible poisoning, fpr
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
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 watcli 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
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
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.
Within the past two decades the function of a safety program in
industry has expanded greatly. Such programs are recognized as
preventive measures 5 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
becoming 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
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 those who have never had any association with
factory conditions and have never been exposed to the kinds of hazards
they present. Their complete lack of industrial experience and their
general unfamiliarity with tools and machinery make it especially
important in their introduction 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.
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
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 lathe 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 handrail to grab. She fell to the floor and broke her
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 lathe-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 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
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 1941
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—stum­
bling, 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 in­
creased 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 (58). Of all injuries reported
to this commission, the proportions that were injuries to women rose
between 1939 and 1943 as follows:

1940 ______________ ___________

6.8 1942
7.1 1943
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.



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). 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 gar­
ments, 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 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 understanding^, 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 are 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 cases 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.

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 with 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
lhat 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
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 wTas 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
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 worker
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
susceptible to clematitis from a solvent used in some opetation, 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.
These consultants will discuss 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 he
the person to establish such community contacts for the women work­
ers and advise them -where they may receive help on their home prob­
lems. 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 folio-wing 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
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.—Leaflets on food, for ex­
ample, designed to be easily read and containing suggestions and
recipes that are simple to follow, can be very useful. It is important
not to overburden the women, already beset by many responsibilities,
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.

(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, in 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, Recommenda­
tions on Hours of Work for Maximum Production, by a committee repre­
senting 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) Lucklesh, 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, National 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. Edward
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) U. S. Dept, of Agriculture, Office of Distribution. Manual of Industrial
Nutrition, 1943, p. 17.
(25) Boudreau, Frank G., quoted in Sappington (see 21), p. 322.



(26) National Research Council, Committee on Nutrition in Industry. Food
and Nutrition of Industrial Workers in Wartime. Reprint and Cir­
cular Series 110, Apr. 1942, p. 2.
(27) Haggard, H. W., and L. A. Greenberg. Diet and Physical Efficiency. Yale
University Press, New Haven, 1935, p. 128.
(28) Haggard, H. W., and L. A. Greenberg. Selection of Foods for BetweenMeal Feeding in Industry, in Jour, of Ainer. Dietetic Assn., Oct. 1941,
p. 754.
(29) U. S. Dept, of Agriculture, Office of Distribution (see 24), p. 9.
(30) National Assn, of Manufacturers. Food, Work and War. New York, 1942,
p. 13.
(31) Hooper, H. A. Dental Services in Industry, in Industrial Medicine, Apr.
1942, Chicago, p. 158.
(32) Schour, Isaac, and Bernard G. Sarnat. Chart, in Sappington (see 21),
facing p. 74.
(33) U. S. Public Health Service, National Institute of Health. Industrial
Hygiene News Letter, March 1944, Vol. 4, No. 3.
(34) Giberson, Lydia G„ in Manual of Industrial Hygiene (see in Brandt, 13),
p. 292.
(35) Sappington (see 21), p. 44.
(36) Gafafer, W. M. Sickness Absenteeism Among Industrial Workers. Third
Quarter of 1943. U. S. Public Health Reports, Yol. 59, No. 11, March 17,
1944. See also earlier reports in this series.
(37) Vernon (see 23), p. 48.
(38) Vernon (see 23), pp. 49 and 56.
(39) Smith, May, and Margaret A. Leiper, quoted by Vernon (see 23), p. 56.
(40) American Standards Assn. Safety Code for Industrial Sanitation in Man­
ufacturing Establishments, Z 4.1, 1935, Rule 3.17.
(41) See Women’s Bureau Spec. Bui. 4, Washing and Toilet Facilities for Women
in Industry. 1942.
(42) See Women’s Bureau Spec. Bui. 2, Lifting Heavy Weights in Defense Indus­
tries. 1941.
(43) Bradbury, W. C., and Charles B. S. Evans. Women in Industry (a study
of 135 riveters), in Industrial Medicine, Oct. 1943, Chicago, p. 690.
(44) Kronenberg, Milton H. Women and Wartime Health Problems, in Indus­
trial Medicine, July 1942, Chicago, p. 334.
(45) Hesseltine, H. Close, in Ohio State Medical Journal, June 1943, p. 548.
(46) 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.
(47) U. S. Public Health Service, National Institute of Health. Letter dated
Nov. 28, 1942.
(48) 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.)
(49) 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.
(50) U. S. Public Health Service, Manual of Industrial Hygiene (see in Brandt,
13), p. 140.
(51) Dublin, L. I., and R. J. Vane, quoted in Manual of Industrial Hygiene (see
in Brandt, 13), p. 139.



(52) Pennsylvania Dept, of Labor and Industry, Bureau of Research and In­
formation. Industrial Injuries in Pennsylvania, 1941, Statistical Sup­
plement, Part II: All Compensable Cases.
(53) Wisconsin Industrial Commission. Workmen’s Compensation Statistics.
Statistical Release 3125, Jan. 13, 1944.
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.
U. S. Dept, of Labor, Women’s Bureau:
The Women’s Bureau will send on request its complete list of publications.
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. oc.
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 Good Posture.

Spec. Bui. 10.

1943. 5c.
When You Hire Women. Spec. Bui. 14. 1944. 10c.
Standards for Maternity Care and Employment of Mothers in Industry.
1943. Prepared by Children’s Bureau and Women's Bureau. (Mult.)
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 the Duties of
Nurses in Industry, in Amer. Jour, of Public Health, July 1943, New York,
pp. 865-881.
Betliune, 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. 386-390.
Perkins, Elna I. Health Education for Industrial Workers, in Industry, June
1943, Associated Industries of Massachusetts, Boston, p. 31.



Davis, Hallowell, Portis, Sidney A., Forbes, W. H., and S. Howard Bartley.
Symposium on Fatigue. Psychosomatic Medicine, April 1943, Vol. 5, No. 2, pp.
Dill, D. B., Bock, A. V., Edwards, H. T., and P. II. 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.
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.) II. N. Macy. Menstrual Exercises, in In­
dustrial Medicine, Sept. 1943, Chicago, p. 588.
Burnell, Max R. 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.
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 iD
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 Dis­
tribution 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.