Peter Holland: a pioneer of occupational medicine.

The earliest recorded occupational health service in this country was that established in a cotton spinning factory at Quarry Bank Mill in Cheshire. The mill was built in 1784 by Samuel Greg and his partners. They employed local labour and also some parish apprentices. Happily, Samuel Greg was a good christian and, having created a modern factory and a model village with a church and a school, he was equally concerned for the physical welfare of his employees. Accordingly, he appointed a doctor to make pre-employment examinations of the apprentices and to visit regularly to deal with the health problems of a community of some 400 people. The man he chose was Peter Holland of Sandlebridge, who had served his medical apprenticeship under Dr Charles White of Manchester. The first record of the employment of a doctor was in 1796, but from 1804 to 1845 (doubtless in response to the early factory legislation) each visit of the doctor was entered in a day book with either an indication of fitness to work or details of the treatment required. The complete record consists of two hardback foolscap notebooks that provide a fascinating insight into the medical practice of the times when the industrial revolution was just getting under way. One of the more interesting features is the preservation of medical secrecy. Dr Holland made his comments on the case in shorthand and his instructions in longhand. By a fortunate coincidence the key to the shorthand was discovered and this has now been largely transcribed. Although much of the content of the diaries is the day by day practice of medicine at the time, there are many illuminating glimpses of the early practice of occupational medicine.     

Peter Holland: a pioneer of occupational medicine.

The earliest recorded occupational health service in this country was that established in a cotton spinning factory at Quarry Bank Mill in Cheshire. The mill was built in 1784 by Samuel Greg and his partners. They employed local labour and also some parish apprentices. Happily, Samuel Greg was a good christian and, having created a modern factory and a model village with a church and a school, he was equally concerned for the physical welfare of his employees. Accordingly, he appointed a doctor to make pre-employment examinations of the apprentices and to visit regularly to deal with the health problems of a community of some 400 people. The man he chose was Peter Holland of Sandlebridge, who had served his medical apprenticeship under Dr Charles White of Manchester. The first record of the employment of a doctor was in 1796, but from 1804 to 1845 (doubtless in response to the early factory legislation) each visit of the doctor was entered in a day book with either an indication of fitness to work or details of the treatment required. The complete record consists of two hardback foolscap notebooks that provide a fascinating insight into the medical practice of the times when the industrial revolution was just getting under way. One of the more interesting features is the preservation of medical secrecy. Dr Holland made his comments on the case in shorthand and his instructions in longhand. By a fortunate coincidence the key to the shorthand was discovered and this has now been largely transcribed. Although much of the content of the diaries is the day by day practice of medicine at the time, there are many illuminating glimpses of the early practice of occupational medicine.     

A Public Celebration of a Personal Doctor

The life of a family doctor is engaged with the people, families, and community he or she serves. Caring changes lives. Yet, we seldom have the opportunity to hear the gratitude or to reflect upon the privilege. In this essay, two family doctors share the experience of seeing a community celebrate the life of their doctor. In these public reflections on their personal doctor, folks reveal how he saw their needs, understood their fears, and partnered with them to create futures. Their stories are compelling evidence that personal doctoring is alive and well and held deeply in the heart of America.     

Court rules nursing home illegally removed cook with HIV

The Appellate Court of Illinois, First District, has upheld the reinstatement of a cook who lost his job after his employer learned of his HIV-positive diagnosis. James W. Davis was placed on unpaid leave by Burton Behr, the administrator of the Raintree Health Care Center in Evanston. Behr did not respond when Davis' doctor sent a requested letter stating HIV could not be transmitted through food preparation. Davis, believing he was fired, filed a discrimination complaint. An administrative law judge and the Human Rights Commission both ruled in Davis' favor. On appeal, Raintree claimed it had made a good faith effort to comply with the State Administrative Code, which lists AIDS as one of the diseases requiring that a nursing home employee be placed on leave until a doctor declares the disease is no longer contagious or infectious. The appeals court ruled that the regulation clearly distinguished between AIDS and HIV. Justice Morton Zwick, writing for the majority, stated that eligibility for employment must be individually determined on the basis of ability to perform a specific job. Although Raintree contended Davis had not been fired, the Court said Davis was constructively discharged when his working conditions were altered so that he could not perform his duties. Dissenting, Justice Thomas R. Rakowski called the doctor's note ambiguous, and said the issue should be judged by what was known about HIV at the time.     

The doctor-patient relationship in history

In the final decades of the XX century the way doctors and patients related to each other changed more than in the twenty-five preceding centuries. The change from a paternalistic to an autonomous model represented a transformation with few historical precedents. The evolution of this phenomenon over time affected the three elements involved: 1. The patient, who had traditionally been considered as a passive receiver of the decisions that the doctor took in his name and for his benefit, was transformed at the end of the XX century into an agent with well-defined rights and a broad capacity for autonomous decision-making on the diagnostic and therapeutic procedures, which were offered to him and no longer imposed on him. 2. The doctor, from being a priestly father-figure (as corresponded to the traditional role of his profession) was transformed into a technical adviser to his patients, to whom he offered his knowledge and advice, but whose decisions were no longer taken for granted. 3. The clinical relationship, from being bipolar, vertical and infantilising, became more collective (with the involvement of numerous health professionals), more horizontal and better adapted to the type of relationship appropriate to adult subjects in democratic societies.     

The joy of family practice

Many family physicians have written about how they influence, nurture, and empower people in their communities of practice. In this essay, the author writes of the personal joys that family medicine has brought him. An expression of his appreciation for his work as a family doctor, it touches on 6 themes that continue to rejuvenate his practice: love, faith, mystery, place, dance, and medicine. By examining the emotional and psychological dimensions of these themes, he offers a path by which other family physicians may be able to find sustenance and joy in their daily work.     

Court puts onus on doctors to warn patients about HIV status

Associate Justice Miriam A. Vogel, in a California appeals court, stated that doctors have an obligation to tell infected patients that they have a contagious disease so that patients and people around them can avoid spreading the illness. A decade ago, physician Eric Fonklesrud of the University of California (UCLA) Medical Center, operated on 12-year-old Jennifer Lawson and did not tell her or her parents that he had discovered that her blood transfusion was contaminated with HIV. Years later, Lawson, unaware she was HIV-positive, had sex with her boyfriend Daniel Reisner, and infected him. Consequently, Reisner filed suit against Fonklesrud and UCLA for damages. Before the suit reached trial, the judge dismissed Reisner's complaint; however, the appeals court concluded otherwise. The appeals court also rejected the defense's argument that the physician's first duty is to his patient, not unidentified third parties. According to the court, California case law obligates the doctor to provide warnings.     

Jury award overturned because defense was denied records

A damage award arising from a medical malpractice lawsuit will go back to the trial judge because the defense was not allowed to inspect the plaintiff's psychological records. Before his death, Timothy B. Baker sued his doctor, Woodruff J. English, claiming the doctor should have known not to prescribe a sulfa-based drug to treat his AIDS-related illness because he was allergic to sulfa preparations. The suit stated claims for negligence and failure to obtain informed consent, and sought recovery on economic damages and damages for emotional distress. On appeal, the doctor argued that he was denied access to Baker's psychological records and contended that the circuit court's refusal to allow discovery of the records hampered his ability to present a defense against the damage award. The appeals court held the records should have been given to the defense. According to the court, any time a plaintiff makes a claim of emotional distress, the defense must be allowed the opportunity to examine the nature and extent of that distress.     

In general practice, 'always expect the unexpected'

CASE STUDY: Mr SF, aged 72 years, presented to a senior colleague complaining of a scalp sore which was failing to heal. The patient had injured his head while mustering cattle 4 years earlier. He consulted his local medical officer at that time and was reassured and sent on his way. Six weeks before presenting to our practice, Mr SF had split his head open again. Although he was not overly concerned about it at the time, it had been slow to heal and he had consulted a naturopath. The naturopath was packing the scalp sore with comfrey leaves and had advised Mr SF to eat curry to aid with its healing. He had been seeing this alternative practitioner each week for the preceding 6 weeks. Mr SF had become disillusioned with the poor results he was getting. At the behest of his wife he was seeking another opinion.     

Houseparents: A vignette

Being with a youngster in crisis means that the adult, too, is involved and may be affected as much as is the youngster himself. The author describes such a situation when a 14-year old has open heart surgery, and its impact on the worker and on the relationship between him and the youngster.The author and his wife are live-in house parents of Torresdale House, a group home for six dependent/neglected adolescent boys operated by St. Francis Vocational School.Clayton, fourteen, came to Torresdale House two years ago. His mother has always had poor health, both physically and mentally. His father left the family when the boy was born. When Clayton contacted his family, he was met with indifference. The boy was raised by a next door neighbor until she had problems of her own and he was placed at Torresdale House.Clayton came with a tendency to magnify everyday life experiences. He also had a habit of turning situations around so that he could derive self-pity—probably in order to reinforce a poor self-image and the idea that he is generally unlucky in life. Clayton has had bad moments at Torresdale House, like stealing 200 dollars from the budget money, but he is generally warm and sensitive. He is small for his age, and has had two medical problems: cysts growing at the tip of his nerve endings, and a heart strain caused by a tight, fleshy substance growing in his subaortic valve which is slowly causing this channel to close. He needed heart surgery.     

Surgeon will pay $10,000 for secretly testing patient for HIV

The Suffolk County (MA) Superior Court ordered Dr. Douglas Wooldridge to pay $10,000 for secretly performing an illegal HIV-antibody test. After Wooldridge stuck himself with a needle during plastic surgery, he drew blood from the patient, Jason Gavann, and sent it to a lab for testing. Wooldridge admitted he performed the test without Gavann's consent, but argued that he did so for a medical necessity. Gavann's attorneys stated that there are no documented cases of a doctor contracting HIV through a needlestick while suturing a patient, and that the only way a doctor would know if he had been exposed to HIV is to have himself tested at the appropriate intervals.     

Funeral director loses claims based on needle puncture

Funeral director Timothy Dunlap lost a claim against his employer, Bergen Funeral Services, following an incident in which he accidentally stuck himself with a contaminated needle. Dunlap was retrieving a body at a home when he stuck himself with a used intravenous needle; only afterwards was he told the deceased had AIDS. He sued the patient's doctor, the hospital where the patient had been treated, the home health provider, and the pharmacy that supplied the IV. Dunlap has tested negative for HIV at least 10 times since the incident. The Supreme Court judge in New York dismissed the suit, saying Dunlap failed to provide evidence that the defendants should have warned him not to dismantle the IV line. The employer said the funeral director should not have dismantled the IV line at the home.     

Some contributions from the doctor of the miners in the Simplon tunnel: The most human of victories. The Provinces of Italy to the Simplon tunnel. The family of the miner at Simplon. 1906

Similarly to Daniele Pometta (1869-1949) on the northern front, Giuseppe Volante (1870-1936) from Turin, a valid clinician and hygiene expert was the field doctor for the firm of Brandt, Brandau e C., on the southern part of the Simplon tunnel for the whole period of its excavation (1898-1906). He meticulously organised and carried out with determination the main mission entrusted him which was to prevent the hookworm epidemic which a mere twenty years earlier had cast its shadow over the St. Gotthard tunnel. Volante also authoritatively directed the first aid post and the hospital that the company built at Nante. Evidence of Volante's vast medical experience was seen in the scientific works he published as well as in a report published in the acts of the International Conference on Work-related Illnesses (Volante, 1906a) and then in a comunication at No. 3 Italian Congress on Work-related Illnesses in Turin (Volante, 1911). There are three interesting works reproduced here (Volante, 1906b-c-d) which are substantially aimed at a broad readership and which clearly illustrate the work carried out, the experience gained and also the author's cultural background. Volante's remarks and the data he supplies are "official" but show no sign of partiality; they convey the grandness of the work he contributed towards creating and in some ways also the "generosity" of the company towards the labour force who "only" went on strike three times for better pay, fewer hours and improved working conditions. Volante's opinion on the low morbidity and mortality of the workers is certainly motivated although it is still relative, first and foremost because he had the tragedy of the St Gotthard as a yardstick, but also because it was swayed by the idea, widespread at the time, of fatalism about the potentially negative effects of the type of work. During the International Conference in 1906 Violante was awarded a gold medal for the work he had conducted, and for three years afterwards he worked under Luigi Devoto (1864-1936) in Milan. After that, he returned to his native Turin where he practised urology. According to his direct descendents, he died aged 64 from respiratory insufficiency the causes of which included a "pneumoconiosis" diagnosed by Prof. Quarelli (1881-1954), a renowned doctor of work-related illnesses, which he had obviously contracted in the period when he had been the doctor of the miners (Gius Volante, 2006).     

From the library of the Netherlands Journal of Medicine. Rudolf Virchow: Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre; 1858

With the publication of Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre in 1858, the author Rudolf Virchow (1821-1902) originated the idea that each cell in each living organism, both plant and animal, originates from another cell and that the origin of disease can only be located in the cell. The book laid the foundations for cell pathology as a scientific discipline and was the most important publication by Virchow, who as doctor and statesman gathered so much fame that he became almost a mythical figure in his own time. The finding that every cell originates from another cell and does not develop from amorphous interstitium is actually attributable to Robert Remak.     

Suit alleges that dental clinic fired hygenist for having HIV

A private Atlanta dental clinic is being sued in Federal court for removing a hygienist after learning he was HIV-positive. The lawsuit alleges that the clinic was afraid of losing business. The hygienist, Spencer Waddell, claims he was told he could no longer treat patients after his doctor notified his employer of his HIV status. He was offered a clerical position at substantially less pay. Although Federal and Georgia statutes allow employers to fire or reassign workers if their disability poses a threat to the health or safety of others, the suit contends Waddell posed no threat. A second lawsuit has been filed against the physician who informed the clinic, charging him with wrongful disclosure of HIV-related information.     

Fired employee settles associational discrimination case

A Pennsylvania man, whose name was not released, and his employer settled an Americans with Disabilities Act (ADA) complaint after he was fired following disclosure that he was gay and that his partner had HIV. The defendant, an employee at Alarmguard in Philadelphia, was subjected to insensitive treatment and ultimately fired after disclosing the information. ADT, Alarmguard's successor, agreed to settle the suit under confidential terms. The agreement sends a powerful message that persons who associate with HIV-infected people are also protected by laws barring discrimination. However, there are few relevant case laws and courts have struggled with how to analyze similar cases under the ADA.     

Pounds

This is the story of a loving relationship between a doctor and a vibrant, elderly woman. In the story, the doctor learns to accept his patient's noncompliance with medical regimens; at the same time, he learns something about his own noncompliance.     

Nontransient third-degree heart block and persistent respiratory findings as sequelae of acute occupational exposure to pyrethroids insecticide

We present the case of a worker with occupational exposure to a pyrethroid insecticide who acutely developed nontransient third-degree heart block. In 2000, a 57-year-old male truck driver on his delivery route was accidentally exposed to pyrethroid insecticide being sprayed for West Nile virus containment. Both the driver and his vehicle were coated with the spray. The exposure was prolonged because he did not change his clothes until after his shift ended and he used the same contaminated truck for a week. Within days, he presented with a third-degree heart block, for which he was emergently treated, and a pacemaker was placed. He had no past history of arrhythmias. In the weeks thereafter, he also developed reactive airway dysfunction syndrome (RADS). In the second decade following the exposure, the patient replaced his pacemaker, confirming the permanent nature of his heart block. In addition to the persistence of his exposure-related RADS, he developed restrictive lung disease and was diagnosed with pulmonary interstitial fibrosis in the absence of established risk factors. The patient died in October 2019 from respiratory illness. Most previous reports of pyrethroid-related disorders are limited to acute exposures, in which transient symptoms predominate. To our knowledge, this is the first report of an exposed worker experiencing permanent third-degree heart block, as well as persistent respiratory findings, as possible short- and long-term sequelae of pyrethroid exposure.     

Jury decides doctor was negligent, but rejects ADA claim

A jury in California ruled that surgeon Franklin Hoaglund was negligent in refusing to operate on a patient with HIV, but did not violate the Americans with Disabilities Act (ADA). Patient Steve Iacovino was awarded $166,000, even though he lost the ADA and civil rights claims. The doctor initially recommended surgery, but changed his recommendations to a more conservative course of treatment that included physiotherapy. The doctor based his recommendation on the patient's low T-cell count, which he believed created a risk of post-operative infection, and current treatment regimen involving large doses of morphine. The patient could not show intentional discrimination by the surgeons.