Document 65v3jez5Qqz3yz4M02oGMeejE

FILE NAME: Railroads (RR) DATE: 1940 June DOC#: RR006 DOCUMENT DESCRIPTION: Proceedings of the 20th Annual Meeting of the Medical and Surgical Section - American Railway Association '& T J IW Y IO & 1A A O % ?' S !V4'*VV -i/--. i PROCEEDINGS OF THE TWENTIETH ANNUAL MEETING OF THE Association of American Railroads M EDICAL A N D SURGICAL SECTION ' i HELD AT PENNSYLVANIA HOTEL, NEW YORK, N. Y. INDEX Page Association oi American Railroads. Board of Directors.......... .......................................................................................... 5 Officers........ .............................................................- ..................... .......................... 5 Operations and Maintenance Department.......................... ................. .................. 6 Operating-Transportation Division: officers............................ ................................ 6 Ballot for members of committee of direction............................................. .................... 78 Bartle, Harvey: address as Chairman................................................ ............................ 17, IS Address at annual dinner.................................................. -....................................... 109-111 Bishoff, M. L.: remarks on "Physical examinations are beneficial to the individual"-- 142-144 Brandabur, J. J.: remarks on epilepsy.-.......................................................................... 118 remarks on blood pressure................................................................... 144-146 Buford, C. H.: address at annual dinner.--..................................................................... 111-115 Chesley, A. J.: remarks..................................................................................................... 123 Committee on medical aspects of air conditioning of cars.--...................... ................... 8, 9 Report of......................................... .. ........................................................................ 123-131 Committee of direction..............................................................................................................6, 7 Committee on disability and rehabilitation..................................................................... 7 Report of...-.....-............................................................... ..................................... .... 19-32 Disous&ion.,..................... ...................................................................-...................... 32-51 Committee on fractures..................................................................................................... 7 Report of............. ........................................................................ --.......................... 66, 67 Committee on developments resulting from physical examinations............................... 7, 8 Report of.............................................. 131-141 Committee on nominations: report of...... ....................................................................... 63, 64 Crowder, T. R.: report as chairman, committee on medical aspects of air conditioning of cars............................................ 123-131 Dandy, Walter E.: address on " Aneurysms of the brain"..... ..................................... 51-63 Dowdall, G. G.: remarks on epilepsy............................................................................... 118, 119 remarks on periodic physical examinations.......................................... 147-149 Election of members of committee of direction............................................................... 64, 108 ' Ferris, F. 8.: discussion on diagnosis of fractures............................................................ 78,79 ^ Garner, J. R.: report as chairman, committee on disability and rehabilitation........32, 115-122 Gray, Howard K.: remarks............................................. ............... ................................ 46, 47 Guthrie, Donald: remarks on "Problems in handling compression fractures of the spine on railroads"........ ............................................................................................... 96-103 Hansen, T. L.: discussion on diagnosis of fractures.................................................. ...... 79 Remarks on mental disease...................................................................................... 120 Horrall, O. H.: report as chairman, committee on developments resulting from physical examinations............................................................................... 131, 141, 147, 149, 150 Kolmblad, E. C.: discussion on diabetes............................................ -............................ 43, 44 Jones, Glenn I.: discussion on foci of infection;........... ................................................... 45, 46 Kennedy, Robert H.: address on "Correlation of fracture work by railroad surgeons with the Committee on Fractures of the American College of Surgeons"....... 80-85 Lancaster, W. J.: discussion on syphilis.....- ................................................................... 48-50 discussion on heatcramps........................ 110 remarks as incomingchairman............................................................ 151 INDEX--Continued Pase Medical and Surgical Section: Annual dinner.......................... ..................................................... ..... Officers............ ............................................................................... Personnel of committees.--............................... ........................... Representatives attending annual meeting--............................... ..... Rules of order___ --.............................................................. ...... Metz, A. R.: discussion on X-Ray series and diagnosis of fractures Remarks on compound fractures................................................. Remarks on insulin..... ................................................................. ..... Remarks on overweight...... ................................... ..................... ........ Murray, Clay Ray: address on "Pathological problems occurring in fractures at the time of injury and in the process of healing" .....-............................................ Myers, Gordon B.r discussion on chemo-therapy.--.......... .......................................... Milsson, J. R.: discussion on transportation of fractures............................................ . Outland, Tom: address on "Treatment of compression fracture of the spine" ......... 209-115 6 6-8 13-15 9-12 76-78 86 117, 118 121, 122 86-96 34-42 68-76 103-108 Sessions of annual meeting: Monday morning, June 10........................................... Monday afternoon, June 10.......................................... Tuesday morning, June 11... ........ ............................... Walker, C. A.: discussion r>n mental disorders................... Weil, Grover C.: remarks on sulfathiazole.......................... Webb, R. C,: report as chairman, committee on fractures. Woolsey, R. A.: discussion on cardio-vascular-renal disease... Zeinert, O. B.: discussion on `pilcpsy. ............. 17-64 ............. 65-108 ............. 115-151 ................. 47,48 ............. 116 .......65, SO. S6, 94 ................ 32,33 ................ 44,45 ASSOCIATION C J. J. Pelley, President &. V. Fletcher, Vice-Presiden C. H. Buford, Vice-President A. F. Cleveland, Viee-Preside E. H. Bunnell, Viee-Presiden tion Department) H, J. Forster, Secretary-Tret B J. J. Pelley, Chairman (ex-ofli L. W. Baldwin, Chief Execute G. B. Brooke, President, Ches M. W, Clement, President, Pe Geo. B. Elliott, President, Atl; E. J. Engel, President and C Topeka & Santa Fe Railw E. S. French, President and Maine Railroad and Maim F. J. Gavin, President, Great 1 J. B. Hill, President, Louisvill W. M. Jeffers, President, Unio A. D. McDonald, President, So Ernest E. Norris, President, St L. R. Powell, Jr., Receiver, Sea E. W. Sclieer, President, Read! M. S. Sloan, President, Missou. Daniel Willard, President, Ralti R. L. Williams, Chief Executive F. E. Williamson, President, N V v r* ;;-o -f.w .!',-.- 6 Association o f American Railroads OPERATIONS AND MAINTENANCE DEPARTMENT C. H. Buford, Vice-President DIVISION I--OPERATING-TRANSPORTATION Officers G. Metzman, Chairman W. K. Etter, Vice-Chairman G. C. Randall, Chairman, General Committee L. R. Knott, Secretary MEDICAL AND SURGICAL SECTION Officers Dr. W. J. Lancaster, Chairman Dr. A. R. Metz, Vice-Chairman J. C. Caviston, Secretary MEMBERS OF COMMITTEES Committee of Direction (Term Expires in 1941) Dr. W. J. Lancaster (Chairman), Superintendent and Medical Director, Re lief Department, Atlantic Coast Line Railroad, Wilmington, N. C. Dr. A. R. Metz (Vice-Chairman), Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Railroad, Chicago, 111. Dr. A. W. Ide, Chief Surgeon, Northern Pacific Railway, St. Paul, Minn. Dr. John R. Nilsson, Chief Surgeon, Union Pacific Railroad, Omaha, Nebr. (Term Expires in 1942) Dr. T. L. Hansen, Chief Surgeon, Chicago, Rock Island & Pacific Railway, Chicago, 111. Dr. G. I. Jones, Chief Surgeon, Southern Railway System, Washington, D. C. Dr. John McCombe, Chief Medical Officer, Canadian National Railways, Montreal, Canada. Dr. G. P. MyerS) Medical Director, New York Central System, Detroit, Mich. (Term Expires in 1943) Dr. Harvey Bartle, Chief Medical Officer, Pennsylvania Railroad, Philadel phia, Pa. Dr. J. Frank Dinneu, Chief Surgeon, Erie Railroad, Cleveland, Ohio. Dr. Donald Guthrie, Chief Surgeon, Lehigh Valley Railroad, Sayre, Pa. Dr. E. V. Milholland, Medical and Surgical Director, Baltimore & Ohio Railroad, Baltimore, Md, 1 Page ............ 109-115 1 .... 6 ............................ 13-15 ............................ 9-12 ............................ 76-78 86 ................... ....... 117, 318 ............................ 121,122 in fractures at the ....................... ..... 80-96 -.......................... 34-42 ............ ........ - ..... 68-76 the fipine"......... 303-108 ..... -............. 17-64 ..................... 05-308 .............................. 115 -151 ..................-........... 47,48 ............................... 116 ........... -...........65, 80, 86, 94 ............................... 32, 33 ! .............. ............... 44, 45 I V 1 a sso c ia t io n of A m erican R ailro ads Officers J. J, Pelley, President R. V. Fletcher, Vice-President and General Counsel (Law Department) C. H. Buford, Vice-President (Operations and Maintenance Department) A. F. Cleveland, Vice-President (Traffic Department) E. H. Bunnell, Vice-President (Finance, Accounting, Taxation and Valua tion Department) H. J. Forster, Secretary Treasurer Board of Directors J. J. Pelley, Chairman (ex-officio). L. \Y. Baldwin, Chief Executive Officer, Missouri Pacific Lines. G. D. Brooke, President, Chesapeake & Ohio Railway. M. W. Clement, President, Pennsylvania Railroad Company. Geo. B. Elliott. President, Atlantic Coast Line Railroad Company. E. J. Engel, President and Chairman of Executive Committee, Atchison, Topeka & Santa Pe Railway. E. S. French, President and Chairman, Executive Committee, Boston & Maine Railroad and Maine Central Railroad Company. F. J. Gavin, President, Great Northern Railway. J. B. Hill, President, Louisville & Nashville Railroad. W. M. Jeffers, President, Union Pacific Railroad. A. D. McDonald, President, Southern Pacific Company. Ernest E. Norris, President, Southern Railway System. L. R. Powell, Jr., Receiver, Seaboard Air Line Railway. E. W. Scheer, President, Reading Company. M. S. Sloan, President, Missouri-Kansas-Texas Railroad. Daniel Willard, President, Baltimore & Ohio Railroad Company. R. L. Williams, Chief Executive Officer, Chicago & North Western Railway. F. E. Williamson, President, New York Central System. m M Proceedings o f Medical and Surgical Section Honorary Members Dr. A. J. Chesley, Secretary-Treasurer, Conference of State and Provincial Health Authorities of North America, St. Paul, Minn. Dr. Thomas Parran, Jr., Surgeon General, Bureau of the Public Health Service, Washington, D. C. MEDICAL AND SURGICAL SECTION STANDING COMMITTEES AS OF AUGUST 1, 1940 Committee on Disability and Rehabilitation I Dr. J. E. Garner (Chairman), Chief Surgeon Western Railway of Alabama, Atlanta, Ga. Dr. E. C. Hohnblad, Regional Surgeon, Railway Express Agency, Inc., 28 East Jackson Blvd., Chicago, 111. 1). C. A. Walker, Chief Surgeon, Southern Pacific Company, Southern Pacific General Hospital, San Francisco, California. Dr. R. A. Woolsey, Chief Surgeon, St. Louis-San Francisco Ry., St. Louis, Missouri. Representative from Committee of Direction Dr. G. I. Jones, Chief Surgeon, Southern Railway System, Washington, D. C. Committee on Fractures Dr. R. C. Webb (Chairman), Chief Surgeon, Great Northern Railway, 1849 Medical Arts Bldg., Minneapolis, Minn. Dr. J. C. Collins, Chief Surgeon, Seaboard Air Line Railway, Seaboard Air Line Bldg., Norfolk, Va. Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga & St. Louis Ry., Hayes St. and 20th Avc., Nashville, Tenu. Dr. O. B. Zeinert, Chief Surgeon, Missouri Pacific Railroad, St. Louis, Missouri. Representative from Committee of Direction Dr. John R. Nilsson, Chief Surgeon Union Pacific Railroad, Omaha, Nebr. Committee on Developments Resulting from Physical Examinations Dr. O. H. Horrall (Chairman), Chief Surgeon, Chicago, Burlington & Quincy Railroad, 547 W. Jackson Blvd., Chicago, Illinois. Dr. M. B. Bishoff, Chief Surgeon, Atchison, Topeka & Santa Fe Railway, Topeka, Kansas. Dr. J. J. Brandabur, Assistant Supervising Surgeon, Chesapeake & Ohio Railway, Huntingdon, West Virginia. D r. G . G . D o w d a ll, C h ie f S u rg e o n , I llin o is C e n tra l System, 5800 Stoney Island Ave., Chicago, Illinois. 8 Association of American Sailroads Representative from Committee of Direction Dr. Geo. P. Myers, Medical Director, New York Central System, 803 Michi gan Central Station, Detroit, Michigan. Committee on Medical Aspects of Air Conditioning of Cars Dr. T. R. Crowder (Chairman), Director Department San. & Surg., Pullman Company, Pullman Bldg., Chicago, Illinois. Dr. D. E. Remsberg, Assistant Superintendent & Medical Director, Relief & Pensions Dept., Norfolk & Western Railway, Roanoke, Ya, Dr. Robt. S. Yancey, Medical Director, Missouri-Kansas-Texas Railroad, Sparta, Illinois. Representative from Committee of Direction Dr. E. V. Millxolland, Medical and Surgical Director, Baltimore & Ohio Railroad, 200 Baltimore & Ohio Bldg., Baltimore, Maryland. 1 Proceedings of Medical and Surgical Section 9 ASSOCIATION OF AMERICAN RAILROADS a DIVISION I--OPERATING-TRANSPORTATION MEDICAL AND SURGICAL SECTION I RULES OF ORDER 1. REPRESENTATION: As provided in the Plan of Organization, the I representation of member roads in tire Medical and Surgical Section shall be Chief Surgeons or other persons engaged in a similar capacity. The Railway Express Agency, Inc., and the Pullman Company are eligible for membership 3 in this Section. f 2. AFFILIATED MEMBERS: A representative of an organization collaborating or cooperating with the Section may become an aililiated mem ber thereof upon the approval of his application by the Committee of Direction. An affiliated member shall have the rights and privileges accorded a member road representative, except voting or the holding of office. Officers and Committees 3. The officers of the Section shall consist of a Chairman, Vice-Chairman and Secretary. (a) As provided in the Plan of Organization, the CHAIRMAN and VICE-CHAIRMAN shall be selected by the Committee of Direction from its membership. Their terms of office shall be one year. A Chairman will not succeed himself. (b) The SECRETARY will be appointed by the General Committee of the Division. His salary shall be named by that Committee, subject to * the approval of the Vice-President, Operations and Maintenance De partment. (c) The COMMITTEE OF DIRECTION will consist of twelve mem bers, territorially representative as far as practicable--one each from New England and Canada; four from the East; two from the South and four from the West--elected as hereinafter prescribed, each of whom shall serve for three years. The terms of office of all elective members of the Committee of Direction shall expire at the conclusion of the annual meeting. Vacancies in the committee membership shall be filled by appointment of the Com mittee until the next election. In addition to the above, the Surgeon-General of the United States Bureau of Public Health Service or a representative to be designated by him, and a representative to be designated by the Conference of State and I PofrothviencCioalmHmeiattletheAofutDhiorreictiteiosno.f North America shall be honorary members F 10 Association o f American Railroads The Committee of Direction will select from its elective membership a Chairman and Vice-Chairman of the Section, whose terms of office shall be one year. A Chairman will not succeed himself. (d) The Standing Committees of the Section will be as follows: Committee on Disability and Rehabilitation Committee on Fractures Committee on Developments Resulting from Physical Examina tions Committee on Medical Aspects of Air Conditioning of Cars The representation of member roads on these committees will be, so far as is practicable, territorially selected, in approximately the same pro portions as that of the Committee of Direction, personnel to be named each year by the Committee of Direction immediately following adjourn ment of the annual meeting. Duties of Officers 4. The CHAIRMAN shall have general supervision over the affau-s of the Section and shall preside at meetings of the Section and at meetings of the Committee of Direction. 5. The VICE-CHAIRMAN, in the absence of the Chairman, shall perform the duties of the Chairman and such other duties as may be assigned. 6. (a) The SECRETARY shall perform the usual duties of that office and such other duties as may be assigned to him by the Chairman. (b) He shall receive six weeks in advance of the annual meeting each year the report of the Committee on Nominations, as elsewhere provided for, and will submit to the membership at the annual meeting the nomina tions contained in that report, to fill the vacancies in the membership of the Committee of Direction. He shall announce the result of the election promptly to the members. Duties of Committees 7. The COMMITTEE OF DIRECTION shall: (a) Exercise general supervision over the interests and affairs of the Section. (b) Be empowered to act on behalf of the Section in the interim between meetings and shall submit at each meeting a report covering its actions. (c) Examine and decide what portion of communications, papers and reports shall be submitted at the meetings. It shall determine which, if any, of the subjects presented by the various committees, shall be referred to the General Committee of the Division. (d) Appoint two months in advance of the annual meeting each year a Committee on Nominations, consisting of representatives of five member roads, who shall not be members of the Committee of Direction. (e) Appoint additional committees as required. (f) Submit to the Chairman, General Committee, detail of con templated financial requirements for conducting the work of the Section as required or as called for by that official. -inL V-'ilW&'; .Railroads :t from its elective membership ction, whose terms of office shall a d himself. Section will be as follows: jhabilitation suiting from Physical Exarnina- of Air Conditioning of Cars these committees will be, so far i approximately the same pro motion, personnel to be named immediately following adjourn- rs jervision over the affairs of the Section and at meetings of the of the Chairman, shall perform ties as may be assigned, usual duties of that office and im by the Chairman, ice of the annual meeting each nations, as elsewhere provided lie annual meeting the nominavacancies in the membership of jounce the result of the election tees all: .he interests and affairs of the e Section, in the interim between ig a report covering its actions, of communications, papers and j5. It shah determine which, if us committees, shall be referred die annual meeting each year a representatives of five member immittee of Direction, squired. 1 Committee, detail of con noting the wort of the Section 1. Proceedings o f Medical and Surgical Section 11 (g) Call annual meetings of the Section, subject to the approval of the General Committee of the Division, if in its judgment conditions warrant. (h) Call meetings of the Section, upon not less than thirty days' notice to each member. I t must call special meetings of the Section upon the request, in writing, of a majority of the member roads. 8. The COMMITTEE ON NOMINATIONS, appointed as above prescribed, shall report to the Secretary at least six weeks in advance of the annual meet ing of each year, a t least two nominations for each impending vacancy to re place the four members of the Committee of Direction whose terms expire that year, and to fill any vacancy. The duties of the Standing Committees shall be as follows: 9. COMMITTEE NO. 1--The COMMITTEE ON DISABILITY AND REHABILITATION shall study and report, with suggestions or recommenda tions, on such subjects, that have to do with the physical efficiency or ineffi ciency of railroad employes. It shall also consider ways and means for the rehabilitation of injured or incapacitated employes and the complete restora tion of function. 10. COMMITTEE NO. 2--The COMMITTEE ON FRACTURES shall study and report on the treatment and transportation of fracture cases includ ing (a) Diagnosis of fractures, (b) First aid and transportation splints, (c) Fracture report forms, (d) X-ray work in connection with fractures, and similar subjects. 11. COMMITTEE NO. 3--The COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS shall analyze and make report, with recommendations or suggestions, on data made available by periodic examinations, etc. It shall study and revise as conditions may warrant, the recommended standards covering physical examinations as well as the forms used in connection therewith. 12. COMMITTEE NO. 4--The COMMITTEE ON MEDICAL ASPECTS OF AIR CONDITIONING OF CARS shall study and report on this subject in its relation to the health and comfort of travelers, cooperating with other de partments handling matters relating to air conditioning of equipment. 13. VOTING AT MEETINGS OF SECTION: (a) Vote may be taken viva voce, by rising, by roll call or by ballot. Each member road shall be entitled to one vote. The vote of the majority of the member roads represented shall be required to decide any question, motion or resolution, unless otherwise ordered, (b) Voting for candidates for membership on the Committee of Direction shall be by ballot, (c) Unless otherwise designated by it, the ranking officer will be recognized as the voting representative of a road at any meeting. 14. LETTER BALLOTS may be taken upon any subject by order of the Committee of Direction and must be taken on all questions affecting physical property. The voting power of the member roads shall be proportionate to the ownership of miles of track. 11 ' i ir, $; t i: I Association o f American Railroads 15. ORDER OF BUSINESS: The order of business at meetings of the Section shall, unless otherwise directed by a majority of the members present, be as follows: Approval of minutes of last meeting Reports of Standing Committees Reports of Special Committee Reports of Tellers Unfinished Business New Business 16. Robert's Rules of order shall govern the proceedings of this Section, including amendment to these Rules of Order. Proceedings of MEDICAL A Pennsylvania Hotel, The following representative Members Alton R. R................................ Ann Arbor R. R...................... Atehison, Topeka & Santa Fe Atlanta & West Point R. R..... Atlantic Coast Line R. R.. Baltimore & Ohio R. R........... Baltimore & Ohio Chicago Te R. R........................................ Canadian National Rys............ Chesapeake & Ohio Ry.............. Chicago & Illinois Midland Ry.. Chicago, Burlington & Quincy R Chicago, Milwaukee, St. Paul cifie K. R............................... 'Chicago, North Shore & Milv R. R........................................ Chicago, Rock Island & Pacific Delaware & Hudson R. R. Corp Denver & Rio Grande Western . Detroit & Toledo Shore Line R. Detroit, Toledo & Ironton R. R Erie R. R.................................. Georgia R. R......................... Grand Trunk Western R. R.. Great Northern Ry................ *Associate Member. 14 Association o f American Eailroads Gulf, Mobile & Northern R. R........... C. H. Ramsay, Chief Surgeon. Illinois Central System....................... G. G. Dowdall, Chief Surgeon. Lehigh Valley R. R............................ Donald Guthrie, Chief Surgeon. Louisiana & Arkansas Ry...................A. A. Herold, Chief Surgeon. Missouri Pacific R. R. ...................... O. B. Zeinert, Chief Surgeon. Montour R. R..................................... G. C. Weil, Surgeon. Nashville, Chattanooga & St. Louis Ry...................................................... L. W. Edwards New York Central System..................G. P. Myers, Medical Director. G. B. Myers. New York, Chicago & St. Louis R y....J. Prank Dinnen, Chief Surgeon. Norfolk & Western Ry...................... D. E. Remsberg, Assistant Superin tendent and Medical Director. R. P. Elder, Medical Examiner. H. G. Mumma, Medical Examiner. P. E. Topham, Medical Examiner. Northern Pacific Ry............................ A. W. Ide, Chief Surgeon, Eastern District. Pennsylvania R. R..............................Harvey Bartle, Chief Medical Exam iner. Walter Aye, Medical Examiner. A. P. Harrison, Medical Examiner. L. S. Howard, Medical Examiner. C. R. Houehins, Secretary to Chief Medical Examiner. S. W. Hurst, Medical Examiner. A. P, Tsenberg, Company Surgeon and Medical Examiner. T. B. L. Jordan, Medical Examiner and Company Surgeon. R. C. Kell, Neuropsychiatrist. J. E. Nickel, Medical Examiner. R. D. Saul, Medical Examiner. J. II. White, Medical Examiner. Pennsylvania-Beading Seashore Lines A. P. Isenberg, Company Surgeon and Medical Examiner. Pullman Company ..... .........................R. M. Graham, Chief Medical Exam iner. Railway Express Agency, Inc............. E. C. Iloknblad, Regional Surgeon. Reading Company ...............................P. S. Ferris, Chief Medical Officer. A. Neupauer, Superintendent Relief Association. St. Louis-San Francisco' Ry...............R. A. Woolsey, Chief Surgeon. St. Louis Southwestern Ry.................William Hibbitts, Chief Surgeon. Seaboard Air Line Ry........................ Joseph D. Collins, Chief Surgeon. Southern Pacific Co.-Pacific Lines...... C. A. Walker, Chief Surgeon. Southern Railway System................... G. I. Jones, Chief Surgeon. Spokane International Ry................. E. R. Northrop, Chief Surgeon. Spokane, Portland & Seattle Ry......... E. R. Northrop, Chief Surgeon. Texas & New Orleans R. R.................Judson L. Taylor, Chief Surgeon. Proceedi Toledo Terminal R. R. Union Pacific R. R........ Wabash Ry..................... Western Maryland Ry... Western Railwav of Alal American College of Sur Association of American Columbia University ........ Crippled Children's Hosp betbtown, Pa. ............... Johns Hopkins University State and Provincial Healt ties of North America `Associate Member. -"' .^,,..-a^liW M aW ^IIIIW Bn> I iilMrftn Proceedings of Medical and Surgical Section 13 M EDICAL AND SURGICAL SECTION Pennsylvania Hotel, New York, N. Y., June 10-11, 1940 The following representatives were present: Members Representatives Alton R. R........................................... E. V. Milholland, Medical Director. A m Arbor R. R..................................A. M. Hume, Chief Surgeon. Atchison, Topeka & Santa Fe Ry......M. L. Bisholi, Chief Surgeon. Atlanta & West Point R. R ..............J. R. Garner, Chief Surgeon. E. II. Greene, Local Surgeon. Carter Smith, Consulting Internist. Atlantic Coast Line R. R.....................W. J. Lancaster, Superintendent and Medical Director, Relief Depart f* ment. J. W. Roberts, Secretary to Supt. and Med. Dir. Relief Department. Baltimore & Ohio R. R...................... E. V. Milholland, Medical and Sur gical Director. Baltimore & Ohio Chicago Terminal R. R................................................... E. V. Milholland, Medical and Sur gical Director. f. Canadian National liys...................... John McCombe, Chief Medical Officer. Chesapeake & Ohio Ry........................J. Frank Diiuien, Supervising Sur geon. J. J. Braudabur, Assistant Supervis ing Surgeon. G. S. Hartley, Physician. * Chicago & Illinois Midland Ry........... Don Deal, Chief Surgeon. Chicago, Burlington & Quincy R. R..... 0. H. Ilorrall, Chief Surgeon. Chicago, Milwaukee, St. Paul & Pa cific R. R..........................................A. R. Metz, Chief Surgeon. "Chicago, North Shore & Milwaukee f R. R................................................... Hart E. Fislier, Chief Surgeon. Chicago, Rock' Island & Pacific Ry-- T. L. Hansen, Chief Surgeon. l Delaware & Hudson R. R. Corp......... J, \y. Ghormley, Surgeon. . Denver & Rio Grande Western R. R.- G. II. Curfman, Chief Surgeon. R. S. Allison, Asst. Chief Surgeon. Detroit & Toledo Shore Line R. R......B. W. Stoekwell, Chief Surgeon. Detroit, Toledo & Ironton R. R..........Roy D. McClure, Chief Surgeon. Erie R. R............................. :...............J, Prank Dinnen, Chief Surgeon. It J. W. Houk, Assistant to Chief Sur geon. Georgia R. R........................................J- B. Garner, Chief Surgeon. E. H. Greene, Local Surgeon. Grand Trunk Western R. R...,........... B. W. Stoekwell, Chief Surgeon. Great Northern Ry.............................. R. C. Webb, Chief Surgeon. I ^Associate Member. 1 . ; i ... ...... il il Railroads Ramsay, Chief Surgeon. Dowdall, Chief Surgeon, i Guthrie, Chief Surgeon. Herold, Chief Surgeon. Zeinert, Chief Surgeon. Weil, Surgeon. Edwards Myers, Medical Director. Myers. ink Dinnen, Chief Surgeon. Remsberg, Assistant Superinlent and Medical Director. Elder, Medical Examiner. Muumia, Medical Examiner. Topkam, Medical Examiner. . Ide, Chief Surgeon, Eastern riet. y Bartle, Chief Medical Exam- i: Aye, Medical Examiner. Harrison, Medical Examiner. Howard, Medical Examiner. Houchins, Secretary to Chief lieal Examiner. Hurst, Medical Examiner. Isenberg, Company Surgeon and lieal Examiner. L. Jordan, Medical Examiner Company Surgeon. Kell, Neuropsychiatrist. Nickel, Medical Examiner. Saul, Medical Examiner. White, Medical Examiner. Isenberg, Company Surgeon and lieal Examiner. Graham, Chief Medical Exam- i Holmblad, Regional Surgeon. Ferris, Chief Medical Officer, eupauer, Superintendent Relief ociation. Woolscy, Chief Surgeon, on Hibbitts, Chief Surgeon, h D. Collins, Chief Surgeon. Walker, Chief Surgeon. Jones, Chief Surgeon. Northrop, Chief Surgeon. Northrop, Chief Surgeon, n L. Taylor, Chief Surgeon. Proceedings o f Medical and Surgical Section 15 ` Toledo Terminal R. B.......................T. H. Brown, Surgeon. Union Pacific R. R.............................. John R. Nilsson, Chief Surgeon. Howard K. Gray, Consulting Surgeon. Wabash By............................................W. E. Gollings, Superintendent Wa bash Hospitals, Western Maryland By.........................E. C. Warring, Sr., Chief Resident Surgeon. Western Railway of Alabama............ J. R. Garner, Chief Surgeon. also American College of Surgeons.......... R. H. Kennedy, Chairman, Committee on Fractures and Other Traumas. Association of American Railroads ...O. II. Buford, Vice-President, Opera tions and Maintenance Depart ment. J. C. Caviston, Secretary, Medical and Surgical Section. W. J. Farrell, Secretary, Purchases and Stores Division. Columbia University ......................... Clay Ray Murray, Associate Professor of Surgery. Crippled Children's Hospital, Eliza bethtown, P a..................................... Tom Outland. Johns Hopkins University..................W. E. Dandy, Adj. Professor of Neuro-Surgerv. State and Provincial Health Authori ties of North America....................A. J. Chesley, Secretary. `Associate Member. ait Saroads aittee appointed by the Secretary coming from the national labor a the group o twelve, two labor Labor, two from the C.I.O., and i group, or that which caused the ider pre-employment examinations he first day. We spent six hours hours, I think the consensus was ots should bo excluded from any o far as pre-employment examina- r discussion in this meeting, but et to discuss it in a public way, vith favor upon the results of the e examinations. I t is claimed that mployable group. Therefore, it is .int to the slightly handicapped or ini. It has been stated that periodic iduals out of work. I t is simply a dude from it those individuals who ,ve other handicaps. Our records to measures as safety factors and at efulness of such persons, or two thoughts that I wanted to specially with the background that the work that we have accomplished the twenty years of our existence. Twentieth Annual Session of this r, whom we all know, as Chairman t the Committee on Disability and Proceedings o f Medical and Surgical Section 19 (Circular M. A S. 222) ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION Dr. J. R. Garner (Chairman), Atlanta & West Point Railroad, Western Railway of Alabama, Georgia Railroad. Dr. E. C. Hoimblad, Regional Surgeon, Rail way Express Agency, Inc. Dr. C, A. Walker, Chief Surgeon, Southern Pacific Company. Dr. R. A. Woolsey, Chief Surgeon, St. LouisSan Francisco Railway. Representative of Committee of Direction Dr. W. J. Lancaster, Superintendent and Medical Director, Relief Department, Atlantic Coast Line Railroad. New York, N. Y., May 15, 1940. To the Medical and S obgicai, Section: Your Committee on Disability and Rehabilitation, having continued to function during the fiscal year, submits herewith report covering its activities. A vast amount of the Committee's work has been carried on through corre spondence by the several members of the Committee handling subjects assigned to them and later reporting to the Committee as a whole at its several meet ings held: November 15, 1939, at Pittsburgh, Pa., February 8, 1940, at St. Louis, Mo., and March 29, 1940, at New York, N. Y. Many subjects brought to our attention and found to have been pre viously investigated and reported upon are omitted at this time, wherever no additional information was obtainable. Quite a few subjects are brought to your attention without special emphasis, while a number of major subjects, though previously reported to this Body, are of such paramount importance that your Committee has devoted considerable time to the amassing of addi tional data and in addition to publication in this report, arrangements have been made for special presentation of these topics by invited guests or members of the Committee. Consideration of the following topics is invited: Cardio-Vascular-Renal Disease Because of the very pronounced hazard cardio-vascular-renal syndrones hold for the railroad employe, his associates and the public, your Committee feels that it cannot too strongly reiterate the reports previously presented on this subject. The early detection of these conditions in train service employes, particu larly engineers, where a rupture of an aortic aneurysm or the sudden onset of a coronary block might be productive of dire results, is of paramount importance. ?. tr: 20 Association o f American Bailroads For this reason we cannot too strongly urge periodic physical reexamination of all employes engaged in any form of train service, and when such employes are found to have a blood pressure above normal, and an irregular or inter mittent pulse, an arteriosclerosis, or a heart exhibiting some valvular anomaly, they should be submitted to examination as often as every thirty or sixty days. When the conditions are more grave they should, of course, be removed from service. A systolic blood pressure of 200 or more and/or a diastolic pressure of 100 should be considered in this group. In examining these cases the Surgeon should remember that trepidation and excitement attendant upon the examination may have considerably raised the blood pressure when the reading is first made. It is therefore recommended that a second or third reading should be taken before establishing the exam inee's blood pressure. Chemo-Therapy The subject of chemo-therapy has become one of marked importance to the medical profession. This term first used by Ehrlich, and restricted to a special class of synthetic organic compounds, has enlarged greatly with the development of the aniline dye industry of Europe. Some of these dyes were found to have inhibitory powers over bacteria and to be more or less selective in their action. Ehrlich first demonstrated that this selectivity of action could be modified by chemical manipulation of the molecule, resulting in an entirely different synthetic organic compound. Many drugs coming under this heading have been so widely used since Ehrlich's early discoveries that they require no special mention. Your Com mittee has given much time and investigation to the newer chemo-therapeutic products--sulfanilamide, sulfapyridine and sulfathiazol, and it is to these that we particularly invite your attention. Rather than incorporating an extensive digest of these newer chemo-thera peutic agencies in this Report, the Committee has been fortunate in its ability to have Dr. Gordon B. Myers of the Wayne University Medical College, Detroit, Michigan, who has had much experience, of a practical nature, with these newer drugs, present this subject. For those members desiring to make a more complete study of the subject, reference is made to the following bibliography: "Preparation and Administration of Arsphenamine and Neoarsphenamine, Treasury Department, U. S. Public Health Service, Hugh S, Cumming, Surgeon General, Reprint #774, Public Health Reports. August 4, 1922, pp. 1867-1882. The Relative Parasiticidal Value of Arsphenamine and Neoarsphenamine, Carl Voegtlin and D. W. Miller, Reprint #776, U. S. Public Health Reports, July 7, 1922, pp. 1627-1641. Principles and Practice of Chemotherapy with Special Reference to the Specific and General Treatment of Syphilis, John A. Kolmer, W. B. , Saunders Co., 1926. Some Applications of Organic Chemistry to Biology and Medi cine, George Barger, McGraw-Hill Book Co., 1930, Chapter IV. (Chemotherapy.) Recent Advances in Chemotherapy, G. M. Findlay, P. Blakiston's Son & Co., Inc., 1930. Proceedings o f Medical and Surgical Section 21 Transactions of The Royal Medico-Chirurgical Society of Glasgow, Session 1935-1936, Meeting I---4th October, 1935, Presidential Address: Chemotherapy--The Progress of Thirty Years and the Prospect, Professor C. H. Browning. Prolegomenon To Current Pharmacology, Chauncey D. Leake, Uni versity of California Publications in Pharmacology, Volume 1, No. 1, pp. 1-30, University of California Press, Berkeley, 1938. Sulfanilamide Therapy of Bacterial Infections, with Special Reference to Diseases Caused by Hemolytic Streptococci, Pneumococci, Men ingococci and Gonococci, Ralph R. Mellon, Paul Gross and Frank B. Cooper, Charles C. Thomas, Publisher, Baltimore, Md., 1938. The Clinical and Experimental Use of Sulfanilamide, Sulfapyridine and Allied Compounds, Perrin H. Long and Eleanor A. Bliss, The Mac Millan Company, New York, 1939. Chemistry in Medicine, The Chemical Foundation. The Clinical Use of Sulfamethylthiazol in Infections Caused by Staph ylococcus Aureus: Preliminary Report, W. E. Herrel and A. E. Brown, Proc. Staff Meetings of the Mayo Clinic, 14, 753, 1939 (Nov. 29). Specific Chemotherapy of Experimental Staphylococcus Infections with Thiazol Derivatives of Sulfanilamide, O. W. Barlow and E. Homburger, Proc. Soc. Exptl. Biol. Med. 42, 421, 1939 (Nov.). Chemotherapeutic Evaluation of Sulfanilamide Derivatives of Hetero cyclic Amines, Frank B. Cooper, Paul Gross and Marion Lewis, Proc. Soc. Exptl. Biol. Med. 42, 421, 1939 (Nov.). Therapeutic Effect of Sulfathiazole and Sulfapyridine, C. M. McKee, Geoffrey Rake, R. 0. Greep and H. B. van Dyke, Proc. Soc. Exptl. Biol. Med. 42, 417, 1939 (Nov.)." Common Colds The 1939 Report dealt fairly extensively with the subject of common colds, enumerating certain prophylatie measures--both hygienic and medicinal. Since there seems to be an increased interest in the use of oral vaccine for the prevention of common colds among railway employes, this subject has been discussed at considerable length. I t has been thought by many that hypodermically administered vaccines have proven to be between 60 and 80 per cent effective in the prevention of common colds. The inconvenience of taking hypodermic injections, together with the relatively high cost of same, has seemed to operate against the more extensive use of this form of prophylaxis. Now, the same bacterial content is available for oral administration in either capsules or enteric coated tablets, which are administered: One each morning for a period of 7 days, and then twice a week until twenty (20) in all have been taken. The ease of administration, together with the small finan cial investment required, and the fact that no evil effects from the adminis tration of these oral vaccines have been reported, makes this prophylatie measure one worthy of consideration and trial. Over a period of two years, Dr. Hartwell Joiner made a study involving the history of 880 individuals giving histories of having two or more colds per year preceding the investigation. A summary of his findings is as follows: 22 Assooiatio-n o f American Earoads No. Persons Medication Administered % Persons In Group Free from Colds 300............None (Control).................................................... 12.34 100............Daily Fruit Juice and Saline.............................. 21.00 115............Six Hypodermic Injections.................................66.61 115............Eight Hypodermic Injections............................ 68.70 130............ Twenty Capsules by Mouth......... ..................... 75.24 120............Twenty Enteric Coated Tablets by Mouth___ 81.92 Your Committee has a list of seventeen (17) large corporations in Chicago who regularly administer oral vaccines to their employes as a prophylaxis against common colds. The enteric coated pills are regarded with the great est favor. Diabetes In 1926-1927, your Committee communicated with Dr. Elliott P. Joslin, Dr. Frederick M. Allen, Dr. R. P. Woodyatt and the Mayo Clinic in an effort to establish what might be considered a normal blood sugar level to guide us in making examinations of railway employes. Their several replies were pub lished in the 1927 Transactions of this Section, and the members are referred to same. It was thought possible that with some twelve years additional experi ence these men may have changed their opinions or have noted some new developments on the subject, and hence they have again been communicated and we herewith quote the replies of Doctors Joslin, Allen and Wilder. Dr. Woodyatt was away from Chicago on an extended visit to the West Coast and could not be heard from up to the writing of this report: Elliott P. Joslin, M.D. Howard F. Root, M.D. Priscilla White, M.D. Alexander Marble, M.D. Allen P. Joslin, M.D. 81 Bay State Road Boston Office hours by Appointment Roentgenologist Isabel K. Bogan, M.D. January 20, 1940. "Dr. J. R. Garner, M.D., Chairman, Committee on Disability and Rehabilitation, Association of American Railroads, 4 Hunter Street, S. E., Atlanta, Georgia. My Dear Dr. Garner: Proof of diabetes should depend upon examinations of both blood and urine. My basis for diagnosis of diabetes is glycosuria plus a fasting (venous) blood sugar of 0.13 (130 milligrams) per cent or a (venous) blood sugar of 0.17 (170 milligrams) per cent at any other time of the day. Diabetics can do much of the work involved in railroading perfectly well and it would be a shame to disbar them from all service. On the other hand, diabetic employes should not be employed in the execution of transportation, e.g., dispatchers, Engineers, conductors, etc. Sincerely yours, (SGD.) E lliott P . Joslin." ilroads % Persons Free from Colds ........................ 12.34 ______ ______ .21.00 ................ ........ 66.61 .......... ........... .68.70 ____________ 75.24 by Mouth___ 81.92 rge corporations in Chicago employes as a prophylaxis re regarded with the great- with Dr. Elliott, P. Joslin, he Mayo Clinic in an effort ood sugar level to guide us sir several replies were pubthe members are referred to lve years additional experis or have noted some new again been communicated in, Allen and Wilder. Dr. visit to the West Coast and eport: Office hours by .d Appointment January 20, 1940. rations of both blood and ia plus a fasting (venous) >r a (venous) blood sugar i me of the day. I in railroading perfectly From all service. On the ployed in the execution of luctors, etc. srely yours, ott P. Joslin." Proceedings of Medical and Surgical Section 23 Frederick M. Allen, M.D. 1031 Fifth Avenue, New York Telephone, Butterfield 8-2151 "Dr, J. R. Garner, A. & W. P. R. R., 4 Hunter Street, S. E., Atlanta, Georgia. January 28, 1940. Dear Doctor Garner: Severe diabetes is common in the young and is also present in a minority of elderly patients. From the occupational standpoint, the distinguishing character of the severe cases is that they require insulin. Although they may enjoy excellent health, presumably the only safe rule for a railroad is that no person who takes insulin can hold any of the most dangerous positions, such as that of locomotive engineer. Other positions should be graded according to danger and responsibility, and the results that might follow if the individual should become either unconscious or mentally confused. Doubtless many station jobs, for example in baggage rooms, could safely be filled by men using insulin if they are efficient in general. In regard to the milder cases, which can be satisfactorily controlled without insulin, my opinion is essentially as expressed in my former letter. Uncontrolled or poorly controlled diabetes, as revealed by exces sively high sugar in either blood or urine, always introduces a chauce of unpredictable accidents. In such cases also the high incidence of arteri osclerosis and the liability to cerebral, coronary and other attacks must receive consideration. On the other hand, a mild diabetic under good control by diet alone need not introduce any danger. My own standards are very strict in requiring thoroughly normal blood sugar in addition to the absence of glycosuria, and the most reassuring statement I can make is that patients under these conditions are as free from dangers of all kinds as non-diabetics of similar ages and conditions. FMA Very truly yours, (SGD.) F r e d e r ic k M. A l e e n ." iIlI I i J i ' h j 24 Association of American Bailroads "MAYO CLINIC Rochester, Minnesota Clinical Section of Dr. Russell M. Wilder Dr. Edwin J. Kepler Dr. Edward H. Rynearson Consulting Dietitian Mary A. Foley January 31, 1940 Dr. J. R. Garner, Chief Surgeon, A. & W. P. R. R.--W. Ry. of A la--Ga. R. R,, 4 Hunter Street, S. E., Atlanta, Georgia. Dear Doctor Garner: It is difficult for me to tell from your letter what you want to know. I have no information to suggest that railroad employes normally show a different physiological range of blood sugar level than other well men. We regard 0.070 and 0.120 gm. per 100 c.c. as the lower and upper limits of normal fasting blood sugar levels, but do not base a diagnosis of dia betes mellitus on the blood sugar value alone because other factors, such as trauma, fever, hyperthyroidism and age, will raise it temporarily. I am forwarding a reprint that may be useful to you, but would also refer you to a book on diabetes which I expect to have published before June. The title is "Clinical Diabetes Mellitus and Hyperinsulinism." The publishers are W. B. Saunders Company, Philadelphia. rmw/hh Sincerely yours, (SGD.) R u s s e l l M. W il d e r , M.D." Giving the subject of Diabetes and its treatment further study, certain con clusions have been formulated. (1) We cannot too strongly emphasize our former recommendations that any train service or engine employe who requires insulin in the treatment of his diabetic condition constitutes a hazard to himself and others and should not be permitted to engage in such train or engine service while such treatment is being administered. (2) The administration of insulin once or twice a week is a dangerous procedure unless the patient is hospitalized. (3) Protamine Zinc Insulin, owing to its uncertain and slow absorption, is more likely to give rise to a hyperinsulin content of the blood than is regular insulin. The drug should be administered with greater care and employes taking same should be controlled in the same manner above described for regular insulin patients. (4) Diabetic gangrene is apparently more prevalent than heretofore. This is thought to be due to the fact that insulin is prolonging the life expectancy of diabetic patients, and that the chemothera peutic effect on the blood vessels i# more manifest. Proceedings of Any person known to have hi of railway train or engine servic working about moving machim climbing should be withheld fron lias never previously bad a simi poral, even epilepsy, must have Emphasis is made upon a pre period of unconsciousness suffe ciently and satisfactorily accoui case of epilepsy. It has been indeed difficult, if i not seen during the seizure. Di perfectly normal individual. Sea seizures, but may only be regarc F< The subject of focal infection 1 in previous reports and the wo emphasizes the importance of at A study was made by a men had spent their life work in vario of this group was 52 years and tl In this group of 208 persons i exist, enumerated as follows: Prostata--........................ T e e th ............................... Tonsils.-............. -............. Sinuses............................. The multiple distribution of fo Prostate and teeth-......... Tonsils and teeth-........... Tonsils, teeth and sinuses. Tonsils and sinuses.......... In the above series all cases t heart being the chief organ invoh cardial degeneration with seleros changes, or other demonstrable e or residual effect. A classification of the cardiac c Diseases of Endocardium: Valvular heart disease.___ MitraL............................... Aorta................. ............... Diseases of the Myocardium. Hypertensive heart disease ( Cardio-Vascular-Renal Synch Diseases of Vessels: Aneurysm of Aorta........... Endarteritis Obliterans.__ Arteriosclerosis Generalize! oads January 31, 1940 what you want to know, mployes normally show a vel than other well men. he lower and upper limits it base a diagnosis of diaecause other factors, such l raise it temporarily, il to you, but would also to have published before is and Hyperinsulinism." Philadelphia. .l M. Wilder, M.D." urther study, certain con- ter recommendations that .0 requires insulin in the itutes a hazard to himself ; to engage in such train jeing administered. :e a week is a dangerous ed. lain and slow absorption, lin content of the blood Id be administered with nould be controlled in the insulin patients, evalent than heretofore, hat insulin is prolonging ind that the chemotheramanifest. Proceedings of Medical and Surgical Section 25 Epilepsy Any person known to have had an epileptic seizure is a hazard in any form of railway train or engine service. Anyone exposed to train service accidents, working about moving machinery, or whose duties require them to do any climbing should be withheld from such employment. The fact that the sufferer has never previously had a similar attack is no defense since everything tem poral, even epilepsy, must have a beginning. Emphasis is made upon a previous recommendation to the effect that any period of unconsciousness suffered by an employe, and not otherwise suffi ciently and satisfactorily accounted for, should be looked upon as a possible case of epilepsy. It has been indeed difficult, if not impossible, to diagnose epilepsy in a person not seen during the seizure. During the interim he may appear as any other perfectly normal individual. Scars on the tongue are suggestive of epileptic seizures, but may only be regarded as subjective evidence. Foci of Infection The subject of focal infection has frequently been brought to your attention in previous reports and the work of your Committee during the past year emphasizes the importance of attention to these sources of infection. A study was made by a member Chief Surgeon of 208 adult males who had spent their life w'ork in various forms of railroad activities. The youngest of this group was 52 years and the oldest 64--the average age being 61 years. In this group of 208 persons a total of 248 foci of infection were found to exist, enumerated as follows: Prostate__..................................................................................... 68 Teeth..............................................................................................136 Tonsils--......................................................................................... 32 Sinuses.......................................................................................... 12 The multiple distribution of foci was found in 40 cases, as foliows: Prostate and teeth.--......................................................................26 Tonsils and teeth -.......................................................................... 9 Tonsils, teeth and sinuses..... ......................................................... 2 Tonsils and sinuses........................................................................ 3 In the above series all cases exhibited a dual or multiple pathology, the heart being the chief organ involved. These cases generally exhibited a myo cardial degeneration with sclerosed or fragile vessels, hypertention, coronary changes, or other demonstrable existing pathology as a precursor, concurrent or residual effect. A classification of the cardiac disabilities W'as as follows: Diseases of Endocardium: Valvular heart disease...................... 18 Mitral............................................................................................ 15 Aorta............................................................................................. 3 Diseases of the Myocardium............................................................128 Hypertensive heart disease (Endo-myocardial)............................. 51 Cardio-Vascular-Renal Syndrone.................................................... 3 Diseases of Vessels: Aneurysm of Aorta....................................................................... 3 Endarteritis Obliterans.--................................................ 3 Arteriosclerosis Generalized with marked Cerebral Changes..... 2 26 Association, o f American Sailroads The conclusions drawn from the above are: (1) Remediable foci of infection are common among railroad workers. (2) There has been a relaxation in the importance of the recognization of foci of infection and prompt elimination of same as an important contributing factor in the production of cardio-vascular disability. (3) Cardio-Vascular disease is an unnecessarily common cause of disabil ity among railroad employes. (4) Programs of education and periodic physical examinations would greatly aid in the improvement of general health, increase of work capacity and efficiency, and the reduction of the incidence of dis abling cardio-vascular diseases. (5) Foci of infection are responsible for organic degenerative changes in the heart and blood vessels. It is especially noted that the finding of one focus of infection should not deter the Examining Surgeon from seeking out other foci which may be equally, possibly more, responsible for the existing disability. This is particu larly shown in the fact that in 70 cases where infected teeth had been found, examination of the prostate disclosed 62 per cent to have infections in this organ. Removal of the teeth and neglect of treatment for the prostatic infec tion would have availed nothing in these cases. A muchly overlooked focus of infection is the colon. When it is recalled that colon bacillus have been found in such distant localities as arthritic joints, the gall-bladder, and even the mastoid, the importance of not overlooking this organ as a focus of infection is apparent. Heat Cramps As the summer months approach, attention well may again be directed to the use of Sodium Chloride for the prevention of "heat cramps." As much as 15 pounds (2 gallons) of water and 25 grams of salt may be thrown oil through the process of sweating by a normal man in tbe course of 24 hours. Hence, it is easily recognizable that the salt loss should be compensated for in order to prevent deleterious effects. Whether the salt intake be in the form of granular salt, salt tablets, or salted w'ater, is immaterial. A member Line instituted the use of salt tablets for the prevention of heat cramps and reports as follows: (1) Employes voluntarily use the tablets. (2) The incidence of heat prostration and other physical effects of dehydration is greatly reduced. (3) Fatigue and physical inertia among employes is considerably less conspicuous when increased quantities of sodium chloride are taken with the drinking water. (4) That diminution of fatigue and other manifestations of salt depletion and of dehydration results in improvement of the morale among employes working during hot weather months and where the con ditions of work cause excessive perspiration. Man-Failure in Connection with Accidents From the study of I. C. C. reports of twenty investigated accidents occurring within a period'of sixty (60) days, only four were found to be due to unpreventable causes, while the remaining sixteen were attributable to man-power Proceedings failure in some form. In tl fifteen deaths and one hundre human and industrial loss wh Much study has been give Committee originated a reco the Association of American recommended standard prao follows: , "Whenever investigate man-failure as a causativ disregard of or misinterf an impaired physical cor medical examination di employes so involved is If all member Lines will ac cedure will undoubtedly lead of much pain and suffering an All Psychiatrists consulted person once having suffered f: rence of such mental aberratic family, and business surroun. breakdown. We cannot too strongly em] individuals who develop any permitted to remain in positic hazardous to themselves or <: Past reports make frequent i classes of railway employes. 1 mind: (1) High blood pressure i (2) Diabetes occurs more (3) Heart, kidneys, and U work put upon then (4) Hernia, especially tb viduals who have which weakens and (5) Overweight predispos organs and funeth existing. (6) People carrying an ext of fat deposited abc interfere with its nc (7) Overweight persons hi physical and rnenta mental dependabilit (8) Tbe continuous regul one of the best safe- an Railroads re: common among railroad workers, importance of the recog n itio n of mination of same as an important iction of cardio-vaseular disability, icess&riiy common cause of disabil- udic physical examinations would of general health, increase of work 3 reduction of the incidence of dis- or organic degenerative changes in f one focus of infection should .not ing out other foci which may be existing disability. This is particulere infected teeth had been found, per cent to have infections in this of treatment for the prostatic infec;ases. n is the colon. When it is recalled i distant localities as arthritic joints, the importance of not overlooking nt. nps ition well may again be directed to tion of "heat cramps." As much as ns of salt may be thrown off through in the course of 24 hours. Hence, it should be compensated for in order >fgranular salt, salt tablets, or salted dt tablets for the prevention of heat .blets. .tion and other physical effects of i. mong employes is considerably less uantities of sodium chloride are taken other manifestations of salt depletion l improvement of the morale among ,weather months and where the con- ; re perspiration. < ;tion with Accidents .enty investigated accidents occurring four were found to be due to unpre:teen were attributable to man-power Proceedings o f Medical and Surgical Section 27 failure in some form. In the sixteen accidents, due to man-power failure, fifteen deaths and one hundred and fifty injuries were reported. An enormous human and industrial loss which might have been prevented. Much study has been given to this subject in the past, and in 1928 the Committee originated a recommendation which has now been approved by the Association of American Railroads for promulgation to the members as a recommended standard practice of the Association. This recommendation follows: "Whenever investigation of any train or train service accident indicates man-failure as a causative factor--such as disregard of signal indication; disregard of or misinterpretation of train orders or rules--and suggests an impaired physical condition as a contributing cause of the failure, a medical examination directed by the Company of the employe or employes so involved is recommended." If all member Lines will adopt and follow this recommendation, the pro cedure will undoubtedly lead to a minimization of accidents, the elimination of much pain and suffering and the preservation of many lives. Mental Disorders All Psychiatrists consulted have expressed the unanimous opinion that a person once having suffered from a mental disorder is more prone to a recur rence of such mental aberration, particularly if he returns to the same social, family, and business surroundings existing at the time of the first mental breakdown. We cannot too strongly emphasize the importance of a firm handling of all individuals who develop any form of mental disorder. They should not be permitted to remain in positions of responsibility or where they may become hazardous to themselves or others. This even after apparent recovery. Overweight Past reports make frequent reference to the dangers of overweight in certain classes of railway employes. Certain basic points should always be borne in mind: (1) High blood pressure is influenced by overweight. (2) Diabetes occurs more frequently in people of overweight. (3) Heart, kidneys, and liver are prematurely exhausted due to the extra work put upon them by the body which is carrying an excess of fat. (4) Hernia, especially the direct inguinal type, may develop in indi viduals who have distended abdomens from excess of fat within, which weakens and over-stresses the abdominal wall. (5) Overweight predisposes to a premature deterioration of vital body organs and functions, which cannot be corrected if too long existing. (6) People carrying an excess of fat naturally have a considerable amount of fat deposited about the heart. This may weaken the organ and interfere with its normal function. (7) Overweight persons have a tendency to become sluggish in both their physical and mental activities. This lessens their physical and mental dependability and predisposes to a slow cerebration. (8) The continuous regulation of body weight by diet and exercise is one of the best safe-guards for continued good health. 28 Association of American Railroads Physiotherapy Your Committee was asked to investigate the problem of physiotherapy and to include recommendations in this Report. We are convinced that there are certain cases in which physiotherapy is undoubtedly of value, but find abuses of physiotherapy to be so many and varied that the practice has almost become a "racket." Our conclusions are as follows: (1) The practice of physiotherapy should always be conducted under properly supervised medical care. (2) Persons are more likely to rely on physiotherapy than to help them selves by returning to work. (3) Physiotherapy is of most use in those who will not help themselves. (4) There is no better physiotherapy than natural work, that is work which is natural for the person involved--his regular duties. Pneumonoconiosis Much time and study is devoted to the subject of pneumonoconiosis, silicosis, anthricosis and allied troubles, by the Air-Hygiene Foundation of America, Inc., which holds its annual meeting at the Mellon Institute in Pittsburgh, Pa., during the month of November of each year. As represen tative of the Association of American Railroads, the Chairman of this Committee has attended these meetings, as previously reported, and was present at the meeting held November 14-15, 1939. A resume of the pro gram is as follows: (1) Mr. Robert J. Watt, International Labor Representative, American Federation of Labor, spoke on "Labor's Viewpoint on Occupational Dis ease Prevention." (2) Mr. Phillip Drinker, Chairman, Preventative Engineering Committee, Harvard School of Public Health, presented a "Report of the Preventative Engineering Committee." He dealt extensively with the washing, cleansing and filtering of air; with toxic vapors and with ventilation. (3) Mr. Theodore C. Waters, Chairman, Maryland Occupational Disease Committee, presented a "Review of Recent. Occupational Disease Legislation." (4) This feature was a Symposium of Reports from the Medical Committee and in this Mr. S. Reid Warren, Jr., Assistant Director X-Ray Laboratory, University of Pennsylvania, spoke on the "Choice of Methods used in Roentgen-Ray Examination of the Chest for Diagnostic Surveys." Dr. Elliott R. Clark, Professor of Anatomy, University of Pennsylvania, reported on "Methods Used in the Microscopic Study of Cells and Tissues in the Living Mammal." Dr. Clark and Mr. Haagensen further reported on "The Reaction of Living Cells and Tissues to Silica Granules as Observed Microscopically in the Living Mammal." (5) A Symposium on "Sick Absenteeism in Industry, Its Extent, Its Causes and Control" was conducted by Dr. A. J. Lanza, Assistant Medical Director, Metropolitan Life Insurance Company. A number of prominent medical men participated in this presentation, including Dr. R. R. Sayers of the United States Public Health Service, and Dr. C. H. Watson, Medical Director, American Telephone and Telegraph Company. (6) "An Employer's Viewpoint on Industrial Health" was presented by Mr. Andrew Fletcher, Vice-President, St. Joseph Lead Company. Proceeding. (7) Mr. V. P. Aheam spo and Public Relations." Reports of General Comit remainder of the session. The general work of the A very closely interlock with tl many details are brought ou immense value to the Railroi Pois Employes working upon repairing and installing telej contact with poison oak, po allusion has been made upon t reports. The following is a si (1) The best prophylaxi such growths to a parts of the body, a heavy lather, wh (2) Those who have con immediately scrub of soap and water tunity of penetrati (3) In cases where the of acetate of lead treatment. (4) Several pharmaceutic treatment for this f from the plant. M ing its use. Puln Your Committee feels it she all employes exhibiting any ac should be held out of service, to work when, after thorough and the suSerer is deemed non- In a previous report (1938 a structural difficulties presentee employe organizations to the rehabilitation of partially disable The transfer of a partially dis: work for which he has been train he is disabled because of some pi tice from the viewpoint of the ei tion policies and programs for tl because of increase in the accider ado; ted and made effective if developed. , - 1IX', IW " `" il nerican Bailroads therapy sstigate the problem of physiotherapy 3Report. We are convinced that there apy is undoubtedly of value, but find and varied that the practice has almost ,re as follows: jy should always be conducted under 1 care. y on physiotherapy than to help them- in those who will not help themselves, rapy than natural work, that is work irson involved--his regular duties. toconiosis to the subject of pneumonoconiosis, :s, by the Air-Hygiene Foundation of meeting at the Mellon Institute in November of each year. As represenm Railroads, the Chairman of this ngs, as previously reported, and was er 14-15, 1939. A resume of the pro- onal Labor Representative, American >or's Viewpoint on Occupational Dis- Preventative Engineering Committee, rented a "Report of the Preventative xtensively with the washing, cleansing and with ventilation, rman, Maryland Occupational Disease cent Occupational Disease Legislation." >f Reports from the Medical Committee i Assistant Director X-Ray Laboratory, on the "Choice of Methods used in Chest for Diagnostic Surveys." Dr. y, University of Pennsylvania, reported Study of Cells and Tissues in the Living nsen further reported on "The Reaction Granules as Observed Microscopically eism in Industry, Its Extent, Its Causes .. J. Lanza, Assistant Medical Director, r. nen participated in this presentation, ited States Public Health Service, and r, American Telephone and Telegraph Industrial Health" was presented by St. Joseph Lead Company. Proceedings o f Medical and Surgical Section 29 (7) Mr. V. P. Aheam spoke on "Impact of Employes Health on Industrial and Public Relations." Reports of General Committees and routine business matters occupied the remainder of the session. The general work of the Air Hygiene Foundation of America, Inc., does not very closely interlock with that of the Association of American Railroads, yet many details are brought out at their annual meetings which can be made of immense value to the Railroads. Poison Oak and Poison Ivy Employes working upon the roadway, cleaning the right-of-way, and repairing and installing telephone and telegraph lines frequently come into contact with poison oak, poison ivy and similar toxic growths. Extensive allusion has been made upon the conditions arising from these sources in former reports. The following is a summary of recommendations: (1) The best prophylaxis is for those likely to come into contact with such growths to apply a coating of laundry soap to such exposed parts of the body, as the arms and hands. This is done by making a heavy lather, which is applied and allowed to dry. (2) Those who have come into contact with these toxic growths should immediately scrub the exposed parts with an abundant amount of soap and water so as to remove the poison before it has oppor tunity of penetrating into the skin. (3) In cases where the characteristic dermititis develops, a solution of acetate of lead applied locally is probably the best form of treatment. (.4) Several pharmaceutical houses now make available an injection treatment for this form of poisoning. This is probably an extract from the plant. Many favorable reports have been made follow ing its use. Pulmonary Tuberculosis L our Committee feels it should reiterate its former recommendation that all employes exhibiting any active manifestation of pulmonary tuberculosis should be held out of service. They should then only be permitted to return to work when, after thorough examination, the case is classed as arrested and the sufferer is deemed non-infectious to others. Rehabilitation In a previous report (1938 and 1939) your Committee has indicated the structural difficulties presented by contracts between the railroads and employe organizations to the promotion of any constructive endeavor in rehabilitation of partial^ disabled employes. 1he transfer of a partially disabled railroad employe from a specific type of work for which he has been trained and in which he is proficient, but for which he is disabled because of some physical defect, would appear to be sound prac tice from the viewpoint of the employe as well as the employer. Rehabilita tion policies and programs for the education and training of men disqualified because of increase in the accident risk created by his physical defect could be adopted and made effective if sympathetic interest and support could be developed. 30 Association of American Railroads The situation at present precludes the adoption and practice of a positive rehabilitation program. There does exist now an opportunity for a form of rehabilitation, which, while it has no particular value to the service accomplishments of the employe, has a human and morale value which should be promoted. This has to do with the preparation, through education, of those employes who are approaching the age in which disqualifying defects and enforced retirement becomes inevitable both in the interest of the longevity of the individual and the preservation of the reasonable degree of collective efficiency of personnel which a properly operated transportation system demands. It is a common experience that railroad employes are psychologically unprepared for retirement because of disqualifying physical defects or of age and are not only separated from the work to which they have devoted their lives, in a most unhappy mental state, but resent and resist the action as an unjust and unreasonable imposition creating an event for which they are neither economically or spiritually prepared. Considering the elements of accident risk and maintenance of average col lective efficiency in railroad operation, it is not unreasonable to assume that practically all railroad employes who reach the age of sixty-five years may expect retirement because of physical defects and that continuance beyond that age will be rare exception rather than the indulgent practice. I t would, therefore, be appropriate to give all employes knowledge of the fact that experience (a) justifies the anticipation of retirement at the age of 65; (b) the transition from active railroad work to mentally less engaging and interesting existence on a retired status creates a sense of insecurity and unhappiness unless some compensating avocation is developed to maintain interest after retirement. It is recommended that appropriate action be taken in the organization of program of instruction and education through the brotherhoods and railroad authorities in order that employes may be fully informed of the necessity of mental interest in the attainment of physical health and contentment when the event of retirement is imposed upon them. Syphilis Too much emphasis cannot be placed upon the importance of impressing syphilitic employes with the fact of syphilis, properly and adequately treated being curable and that their employment will not be interfered with so long as they ,are taking proper treatment, provided their condition is not in a stage to constitute a hazard to others and has not advanced to the point where there is little hope of controlling and curing their malady, and where there is danger of a sudden catastrophe. Quite obviously there is no place in train or engine service for the neuro-syphilitic. In a previous report (1939) reference was made to use of the Klein Test as being reliable as to negative findings, easily and rapidly made, and relatively inexpensive. It seems especially suitable for examination of railroad employes and applicants for employment since in these cases proof of absence of syphilis is paramount. A five-year report from the Pathological Laboratory of one of the States shows that during this period there were made 136,287 Wassermann tests of which 27,162 were reported positive. This was 20 per cent of the total num ber made. This group included 1,774 railway employes examined and 378, Proceedin or 21 per cent, were found dence of syphilis among rai ined were only employes i means constituted a cross-; The importance of spec men as regards their reacti All cases of aortic aneur the presence of such an an specific treatment the pat mended to remove from er aortic aneurysm is detectei All persons are strongly immunization. This is pa not at all times in positic supplies. For some years oral ty other countries but was nc In September, 1937, H. D. their observations on oral Laboratory and Clinical M (1) "Typhoid vaccim concentration human beings cutaneously." (2) "The oral vaccii anti-bodies in a (3) "Xo observed or the oral vaccim (4) "Severe reactions vaccine is giver (5) "People in genera the subcutneo (6) "The oral vaccin less equipment (7) "Economically ai than the subeu) If the oral typhoid vacc form, it has three factors in (1) The absence of m (2) The greater pose intervals. (3) The greater conve Oral typhoid vaccine ai being manufactured by twi "Typhorai" (oral typho mixed vaccine) is manufac filled capsules with the te< hour before breakfast on >* 2ii Baroads ioption and practice of a positive r a form of rehabilitation, which, e accomplishments of the employe, d be promoted. augh education, of those employes qualifying defects and enforced 3 interest of the longevity of the nable degree of collective efficiency asportation system demands, md employes are psychologically lalifying physical defects or of age to which they have devoted their i resent and resist the action as an ;ing an event for which they are d. k and maintenance of average col ls not unreasonable to assume that ffi the age of sixty-five years may is and that continuance beyond that indulgent practice, pve all employes knowledge of the pation of retirement a t the age of 65; ork to mentally less engaging and creates a sense of insecurity and vocation is developed to maintain don be taken in the organization of ough the brotherhoods and railroad "f e fully informed of the necessity of sical health and contentment when hem. s upon the importance of impressing lis, properly and adequately treated t will not be interfered with so long -ided their condition is not in a stage ot advanced to the point where there ir malady, and where there is danger y there is no place in train or engine /as made to use of the Klein Test as lily and rapidly made, and relatively for examination of railroad employes lese cases proof of absence of syphilis cal Laboratory of one of the States j made 136,287 Wassermann tests of ais was 20 per cent of the total numailw&y employes examined and 378, Proceedings of Medical and Surgical Section 31 or 21 per cent, were found positive. This does not fix the percentage of inci dence of syphilis among railway employes at so high a figure since those exam ined were only employes under suspicion or else under treatment and by no means constituted a cross-section of all railroad employes. The importance of special examinations is stressed particularly of engine men as regards their reaction time to external stimuli. All cases of aortic aneurysm are conceded to be of a syphilitic etiology and the presence of such an aneurysm creates so great a hazard, regardless of the specific treatment the patient may receive, that it is unhesitatingly recom mended to remove from engine and/or train service any employe in whom an aortic aneurysm is detected. Typhoid All persons are strongly urged to protect themselves against typhoid by immunization. This is particuiariy important for railway employes who are not at all times in position to control the sources of their food and water supplies. For some years oral typhoid vaccine has been employed in Europe and other countries but was not introduced into the United States until recently. In September, 1937, H. D. Moore and I. L. Brown published a comparison of their observations on oral and parenteral typhoid vaccine in the Journal of laboratory and Clinical Medicine. Their conclusions being: (1) "Typhoid vaccine administered orally produces as great or greater concentration of agglutinin anti-bodies in the blood serum of human beings as the typhoid vaccine administered sub cutaneously." (2) "The oral vaccine brings about this concentration of agglutinin anti-bodies in a shorter length of time." (3) "No observed or reported reaction following the administration of the oral vaccine." (4) "Severe reactions causing loss of time from work do occur when the vaccine is given subcutaneously." (5) "People in general take the oral vaccine more willingly than they do the subcutaneous." (6) "The oral vaccine is more easily administered because it requires less equipment and preliminary preparation." (7) "Economically and practically the oral vaccine is more desirable than the subcutaneous." If the oral typhoid vaccine is relatively as efficacious as is the parenteral form, it has three factors in its favor: (1) The absence of marked reaction. (2) The greater possibility of repeating the immunization a t stated intervals. (3) The greater convenience to the patient. Oral typhoid vaccine and oral typhoid mixed vaccine are now available, being manufactured by two pharmaceutical houses. "Typhoral" (oral typhoid vaccine) and "Typhoral Mixed" (oral typhoid mixed vaccine) is manufactured by Eli Lilly and Company and marketed in filled capsules with the recommendation that one capsule is to be taken an hour before breakfast on three successive mornings. Each "Typhoral" U pagi x Ol u T ^. o C & y U D s /^inaA ftxQsvvb