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272 pupils or other candidates towards whom they might feel a kindly partiality, the examination was conducted so as to assure the anonymity of the candidates. Their numbered but unsigned papers were read aloud i one after the other to the examiners by a staff of interns, to which the doctor in question belonged. By sandwiching these readers aloud in between the examiner and the examinee, it was hoped that the former would not only be saved from the exhausting task of deciphering much spidery MS., but would also find it easier to pass objective judgment. But B unfortunately there seems to have been a widespread I belief among the examinees that extra points could be gained if clues to their identity could be furnished in their papers. The whispers about cheating grew into a murmur, and finally into such a general uproar that official action had to be taken by the Assistance Publique. The official inquiry led to the startling discovery that out of 620 candidates, as many as 282, or 45 per cent. of the total, had sent in one or more papers marked in some distinctive fashion. It has therefore been decided to cancel the original examina- tion. A new examination will be held in a month or two, and new examiners will set new questions to the same candidates. If most of the candidates who were successful in the first examination are so again, a cogent answer will be forthcoming to the old objection that such examinations, even when conducted honestly, put candidates at the mercy of too big an element of chance. But this is a very big "if." THE DOCTOR’S DAY Come, tell me how you live," I cried, " And what it is you do ! " XIII.-AN INDUSTRIAL DOCTOR By an " industrial doctor " I mean a doctor who is employed full-time in a factory. In order to give a more intimate picture of the life, I will give a brief description of the factory in which I work and the size of the medical staff. It should be understood that industrial medicine in this country is developing slowly, and that many factories now have clinics, varying in size from a part-time nurse to a complete staff of full-time doctors and nurses. In the factory where I am employed we make foodstuffs and employ about 5000 workers, of whom rather more than half are men and boys. The medical staff consists of two doctors and three trained nurses, one of whom spends all her time sick-visiting. My clinic reckons to do any work which comes to it, but we do no visiting outside the factory, except (1) to those employees between the ages of 14 and 16 who have no panel doctor, and who ask us to visit them when they are unfit for work ; (2) the visiting done by the nurse, which is more in the nature of social than medical work. The largest proportion of work coming to my depart- ment is very similar to that done in a casualty department of a hospital. Much of the work is sur- gical in type and minor in nature-cuts, bruises, sprains, septic conditions, boils-but there is no limit to the severity of the conditions seen. I keep an emer- gency bag, and am always ready to do any necessary emergency operation in the factory. Several times I have stood by while a machine was taken to pieces in order to release a worker who was trapped in it and badly injured. Such happenings are, however, emergencies, and we are not fitted to deal with these major injuries throughout their course ; we have, therefore, our own ambulance, and we can have any case into hospital within five minutes. On the other hand, moderately severe injuries, such as fractures and lacerated tendons, are not uncommon. THE MORNING AND ITS VICISSITUDES By the time I arrive, about 9 A.M., my clerk has a list of all the people who have asked to see us, and we proceed to send for them. We get them in small batches, and this has to be carefully organised, because we do not want to waste the employees’ and the firm’s time by keeping people waiting unneces- sarily ; on the other hand, we cannot afford to be kept waiting ourselves, because we may have 100 or 150 patients to see, and we always get through this list before dinner-time. By so doing we leave the afternoon free for redressings, accidents, those people who may be taken ill for medical reasons, and for all the other work which we do, and which I shall describe later. Some of the cases will be surgical, some medical, some new, and some we have seen on the previous day. We treat all medical cases which come to us, provided they are fit enough to stay at work. and we do our own dispensing. We make a small charge to recover the bare cost of the drugs used and, with the exception of such things as vaccines, all other treatment is given free. So my morning is spent. Perhaps it sounds fairly straightforward and simple ; sometimes it is, and sometimes it is the very reverse. The average doctor in practice works more or less to his own time, and is almost completely his own master ; in industry, on the other hand, production is always the master, and is ruthless in calling the tune. The work may be done in a constant series of interruptions and inquiries-perhaps about subjects which have only a faint relation to medicine-and one needs much patience and tact. My department has four tele- phones, and there are times when all of them seem to ring all day long. It can be very exasperating to have to break off in the middle of an examination of a chest to answer a telephone inquiry as to the food value and the metabolism of some article, when the information required is only wanted for advertising purposes. Again, the finest organisation in the world can break down and become chaos simply because several accidents have happened about the same time and have to be treated at once, in spite of the fact that a batch of patients we have just sent for have to be kept waiting. Then the great god of production is held up, and many are the questions which have to be answered. Remember that British industry is fighting for its life, and everything depends on a high output. The department is kept open during the dinner hour by sending the nurses off in relays ; this is done because the workers go to dinner at different times, and because many of them have dinner in our own canteen. The afternoon is taken up by all that other work which has to be done. The jobs are many and varied, and I will describe them briefly. VOCATIONAL AND OTHER EXAMINATIONS All applicants for employment are examined. This does not mean that only absolutely fit workers are taken, but rather that many with physical defects are accepted and their owners placed on the work which they can do. This vocational placing can only be done if the doctor has a very detailed knowledge of the various jobs on which the workers are to be put. A record card is made at the time of the examination, and every visit the employee subsequently makes to the department, with all the necessary information, is entered on that record. Obviously, this vocational selection would rapidly become useless unless every worker passed through the department’s hands every time his work was changed. In practice this is done ; although the workers do not always have to be re-examined, because it is sometimes possible to tell if they are suitable by reference to their records. There are, too, many special examinations which have to be made. I keep a list of between 50 and 60 : of our higher executives, for whom I do a complete , overhaul every 6 or 12 months. The firm believes
