Document JNDyEo663my0BqmvLwXDOj8O6

FILE NAME: Railroads (RR) DATE: 1932 June DOC#: RR001 DOCUMENT DESCRIPTION: Proceedings of the 12th Annual Meeting of the Medical and Surgical Section - American Railway Association h / \ /y ~ \ V. )C t '\ / 7 / / / 3 l / y "\ /^ L L y ------- (ly C t 'V L /"'S\ / ts :c i Ji' j,,v I y y ^ ' HE zvy i A 5* i aa mz< $$**$> .,s ^ American Railway Association' PROCEEDINGS;:: A:;.-A;:. : ^ /. . of the ;'.':j. : ;.:'- TWELFTH A N N U A L MEETING of n-iE MEDICAL AND SURGICAL SECTION- PENNSYL'VANIA HOTEL NEW YORK CITY JUNE 13,14,1932 PRO CEEDINGS OF THE TWELFTH A N N U A L MEETING OF THE American Railway Association M ED ICA L A N D SU R G IC A L SECTION HELD AT PENNSYLVANIA HOTEL, NEW YORK CITY JUNE 13, 14, 1932 EaXEKN PiUNTIN'O CoUl`OU,vriON N13W Y o r k , N . Y. 1932 NDEX B an c ro ft, I^rederic Wh: ad d ress on C au ses of F a ilu re in H ealin g in C le a n W o u n d s...... Page 45-50 B o a rd of D ire c to rs, A m erican R ailw ay A sso ciatio n ......................................................... ........... B y-L aw s, change in : re m a rk s of L. A. E n s m in g e r........ ......................................_....................... 5 79, 80 Causes of Failure in H ealing in C lean W ounds: Frederic W. B ancroft. Colum bia Uni v e rs ity C ollege of P h y sician s a n d S u rg eo n s............ .............................................................. 45-50 C o m m itte e of D ire c tio n ............................................................................................................................ 0 C o m m ittee o n D e v e lo p m e n ts R e s u ltin g fro m P erio d ic P h y sic a l E x a m in a tio n s ........... R e p o rt of............ ............................................................................................................................-..... 7 64-70 C o m m itte e on E x te n s io n of U se of S ta n d a rd F ir s t A id P a c k e t.............................................. R e p o rt of._.......................................---.................................................... -........... -............. -.......... D iscu ssio n onTM ........................................... 7, 8 23, 24 24-26 C o m m itte e on F r a c tu r e s ....... ................................................................................................................... R e p o rt of....................................................-- ...................-......................... -................-..................... D iscussion o n ....................................................................................................................... 9 71-73 73-76 C o m m ittee on N o m in a tio n s........ ........................................................................................................... R e p o rt of................................................................................................................................................ 7 36, 37 C o m m ittee on O ccu p atio n al D iseases a n d R e h a b ilita tio n ................................... ..................... R e p o rt of.......... ....................................................................................... D iscu ssio n oil............................................................................................................................. 7 52-62 62, 63 C o m m ittee, J o in t. O n R ailw ay S a n ita tio n ........ ...................................... ................. .................... 8 D enney, C. E ., C h airm an , O p eratin g D ivision (P resid en t, E rie R ailro ad ), rem ark s by.. 50. 51 Dowdall, G. G .: discussion on report of com m ittee on extension of use of stan d a rd first aid p a c k e t............................................................................. 24 D iscussion on use of colored go g g les................................................................................... 43, 44, 7 7 -7 9 D iscussion on eye in ju r ie s ........................................................... 37-39 D iscussion on six h o u r d a y for ra ilro a d em p lo y es...................................... ......................... 42, 7 7 ,7 8 D iscussion on ch an g e in B y -L aw s.... ........................... .............................................................. 79 M o tio n re: te leg ram to W. II. B o h art._ ........................... .................................. - .................. 63 E lection of Officers, M em bers of C om m ittee of D irection an d C om m ittee on N om i n a tio n ......................................................... ................................... ..................................... -.................. A p p o in tm en t of T oilers.............................................. R e s u lt of._.......................................................... Emergency Traction T reatm ent: R obert H. K ennedy, Beckm an Street and 8tuyvesunt S q u are H o sp ita ls............................................................................................................. . - 36, 37 37 76 26-35 E nsm inger, L. A .: re p o rt of co m m ittee on n o m in a tio n s ........ . . ........................... ................ D iscussion on ch an g e in B y -L aw s....................................................-......................................... D iscussion on su rg ical clean lin ess.............................................................................................. - 26, 37 79 80 Eve, D uncan: discussion on rep o rt of com m ittee on developm ents resulting from periodic p h y sical e x a m in a tio n s......................... 70 E y e In ju rie s : rem ark s b y J . C. C a v isto n , S e c re ta ry .................................................................... L e tte r to R . H. A ish to n a n d m e m o ra n d u m co v erin g s u b je c t........................................ 57, 38 39-42 F ro st, J . G .: re p o rt of T ellers as to re s u lt of electio n ........................ ......................................... 76 G arner, J. R .: discussion on report of com m ittee on extension of use of stan d a rd first aid packet..............................................--.......................................................................................... 26 D iscussion on ey e in ju rie s................................................................ ......................-............ .......... 38 D iscussion on use of colored goggles................................................................ ..................... -- 78 G oggles, colored. U se b y eriginem en a n d tra in m e n .......... .................... .................... ................ R em ark s b y C h a irm a n H o p k in s......................................................................................... ......... 42-44 42 H o p k in s, C. W .; rem ark s b y C h a irm a n ...... ................. ~................................................................. 15 H um e, A. M ,: discussion on rep o rt of co m m ittee on extension of use of s ta n d a rd first aid p a c k e t.................................................................................................................................... 26 D iscussion on eye in ju rie s ............................................................ -................................................ 39 D iscussion on use of colored goggles.--...... ..................................... :........................................ 44 IN D E X -- Continued. Lie. A. W .: re p o rt or co m m ittee on ex ten sio n of use of s ta n d a rd first aid p a c k e t........ J o in t C o m m itte e on K ailw ay S a n it a ti o n .................................................................................... .. 2d. 24 8 K en n ed y . R obert i l .: ad d ress on .em erg en cy T ra c tio n T r e a tm e n t....................................... 2 0 -8 5 L eigh, S o u th g a te : discussion on surgical clean lin ess........................................ ........................... 79 M cC om be. J o h n : rem ark s at C h a irm a n -e le c t.................................. .............................................. R e m a rk s reg ard in g W. H . Jto Jia ri...... .............................................................................. ......... 77 M edical and Surgical Section: Officers............ ..................................................................................................................................... P erso n n el of C o m m itte e s .................................................................................................... ;......... R e g u la tio n s ........................................... ...................................... ..... ............................................... fi 0-9 10-12 R e g u la tio n s, change in ................................................................................................................. 79 R e p re se n ta tiv e s a tte n d in g 1982 A nnual M e e tin g ...................... ....................................... id , 14 M oss, I). Ik : re p o rt of eom m itt.ee on o cc u p atio n a l diseases arid r e h a b ilita tio n ............ 51-G2 D iscussion on eye in ju ries .............................................................................................................. 28 M u rra y . C lay R a y : ad d ress on P o tt's .F racture ............................ .............................................. lo-22 20 1 N ilsson, ,). K.: discussion on eye in ju n .- s ......................................................................................... 42 D s n s .'i i i ! on us-' o! <_;>!.n \ d g o g g le s ...................... .. . ............................................... j 80-82 R esult o' periodic pliystred e x a m in a tio n s mi 1'nm n P a c ific ............................................ i Officers oi A s s o c ia tio n .......................... . ................................................................................................ r> ; Oflicers of D ivision ! ... O p e r a tin g ................... ....................................................................... fi Viii'miucr, S. d iscu s-io n <>ii rep o rt of co m m itte e on ex ten sio n uf use of s ta n d a rd iirst aid p a c k e t ... R ep o rt of co m m ittee uu f r a c t u r e s .......................... ................................................................... ] )i.-russion o n ............................................................................................................................. D iscusshm on eye in j u r ie s ............................................. ................................................................ Alot.ion re; te leg ram to \V. fl, H o b a r t...................................................................................... 2o 71-72 78, 74 28 02 P u tt's F ractu re: C lay Kay M u rray . C olum bia F n iv ersity College of Physicians and b u rg e o n s ................................................................................................................................................ lo -22 R eg u latio n s of S e c tio n .................................................................................. 1........................................... 10-12 R e p re se n ta tiv e s in a tte n d a n c e ............................................................................................................. 18, 14 Six H o u r D a y fur R a ilro a d F m p lo y c s: G. G . D ow dai!............................................................... 77, 78 j S urgical C le an lin ess: rem ark s by S o u th g a te L e ig h ....................................................................... 79 ; 04-70 T a y lo r. S, R .: re p o rt of co m m ittee on d ev e lo p m en ts resu ltin g from periodic physical ` e x a m in a tio n ............................................................................................................. ............. -............. F niou Pacific P erio d ic P hysical e x a m in a tio n , resu lt of: J. R. N ils s o n .......................... 80-82 i W ebb, R . C .: discussion on re p e a t of co m m itte e on fra c tu re s ................................................. 74-70 Mb o b e y , R . A .: discussion on re p o rt of co m m ittee on ex tension of use of s ta n d a rd ! 25 26 first aid p a c k e t..................................................................................................................................... , 44 1 D iscussion on use of colored goggles.......................................................................................... i J \ I j I j i R . I! !.. U E. V W . 1 j. M C h u ;1 ].. A. E.. 0 . V. F ilili H a l. E lis a E. E A. C F. U \V. V S ir 1i PevO R. R 0:ui: F. i:. j . ,i. >.p-" -N ;-7 aid p acket JEge 2:5. 2d ............................ - ........... .......... .................................... ........... -.............. .................. iiita tiu n ............ ------------........ ................ ............................ d 0-9 10-12 79 12, 11 51-02 38 15-20 39 43 .............-............. 5 ............................................. ii '*.* uf stan d ard - - ................. -.................. - . 25 71-73 73, 71 33 (12 'O ysiciaas :ii:d .... --- ... ...... 15-23 10-12 ........................ 13. U 77, 78 ....................... `die p h yd e ai ........ 72 61-70 ....................... 8 9 - vj .............. A .standard 71-70 25, 20 44 American Railway Association R. II. Aishton, President M. J. Gormlev, Executive Vice-President W. G. Besler, First Vice-President Hale Holden, Second Vice-President Alfred P. Thom, General Counsel H. J. Forster, Secretary and Treasurer Board of Directors R. Id. Aishton, President, American Railway Association. L. W. Baldwin, President, Missouri Pacific Railroad. K. W. Beatty, Ghairman and President, Canadian Pacific Railway. W. R. Cole, President, Louisville & Nashville Railroad. J. M. Davis, President, Delaware, Lackawanna & Western Railroad. Charles Donnelly, President, Northern Pacific Railway. L. A. Downs, President, Illinois Central System. J. E. Gorman, President, Chicago, Rock Island & Pacific Railway. C. R. Gray, President, Union Paeilie System. Fairfax Harrison, President, Southern Railway System. Hale Holden, Chairman, Executive Committee, Southern Pacific Company. Elislui Lee, Vice-Pi esidenf, Pennsylvania Railroad. E. E. Loomis, President, Lehigh Valley Railroad. A. C. Needles, President, Norfolk & Western Railway. .J. J. Pelley, President, New York, New Haven & Hartford Railroad. F. W. Sargent, President, Chicago & North Western Railway. W. B. Storey, President, Atchison, Topeka & Santa Fe Railway System. Sir Henry W. Thornton, K.B.E., Chairman and President, Canadian National Railways. Percy R. Todd, President, Bangor & Aroostook Railroad. R. B. White, President, Central Railroad Company of New Jersey. Daniel Willard, President, Baltimore & Ohio Railroad. F. E. Williamson, President, New York Central. Lines. J. J. Bemet (ex-officio), President, Chesapeake & Ohio Railway. L. F. Loree (ex-officio), Chairman, Eastern Presidents' Conference Committee. c American Railway Association DIVISION I OPERATING Officers C. E. Denney, Chairman il. Cannon, Vice-Chairman J. C. Cavistori, Secretary MEDICAL AND SURGICAL SECTION Officers Dr. John MeCoinbo, Chairman Dr. \ \ . L. Hartman, First Vice-Chairman. Dr. J. R. Nilsson, Second Vice-Chairman. J. C. Ce vision, Secretary. MEMBERS OF COMMITTEES Committee of Direction (Term expires June, 1933) Dr. John MeCornbe (Chairman). Chief Medical Officer, Canadian National Railways, Montreal, Canada. Dr. W. L. Hartman (First Vice-Chairman), Medical Director, New York Centra] Lines, Detroit, Mich. Dr. J. K. Nilsson (Second Vice-Chairman). Chief Surgeon, Union Pacific Railroad, Omaha, Neb. Dr. G. G. Dowdall, Chief Surgeon, Illinois Centra) System, Chicago, 111. Dr. J. R. Garner, Chief Surgeon, Western Railway of Alabama, Atlanta, Ga. Dr. Donald Guthrie, Chief Surgeon, Lehigh Valley Railroad, Sayre, Pa. Dr. C. W. Hopkins, Chief Surgeon, Chicago & North Western Raihvav, Chicago, 111. (Term expires June, 1934) Dr. Harvey Battle, Chief Medical Examiner, Pennsylvania Railroad, Phila delphia, Pa. Dr. G. W. Cale, Jr., Chief Surgeon, St. Louis Southwestern Railway, Tex arkana, Avk. Dr. F. E. Smith, Chief Surgeon, Wabash Railway, Decatur, 111. Honorary Members Dr. A. J. Chesley, Secretary-Treasurer, Conference of State and Provincial Health Authorities of North America, St. Paul, Minn. Dr. LI. S. Gumming, Surgeon General, Bureau of Public Health Service, Washington, D. C. Dr. D. B. M Burlingto Dr. Duncan : Railway, Dr. A. W. Rh Dr. S. C. Plm Chicago, Dr. S. B. Ta i Dr. 0. lb 7w 3 Louis. M Dr. G. W. ( ! urks.na, Dr. G. Fr.. Dr. D. K. M Quincy L Dr. F. E. Sm Dr. J. R. Ga: Dr. S. It T; Cohunln Dr. W. N. lb Miss. Dr. J. C. L: Lake Oil Dr. J. F. R Denver. Dr. R. D. S' Railroad Dr. Harvey I deiphia. Coma Dr. Id R < Surgery taitn 5 SECTION airman. lirman. fTEES m : ) Officer, Canadian National edieal Director, New York def Surgeon, Onion Pacific d System, Chicago, til. iy of Alabama. Atlanta, C-a. y Railroad, Sayre, Pa. i North Western Railway, t) nn.sylvania Railroad, Phila- outhwestern Railway, Tex- , Decatur, 111. we of State and Provincial ll, Minn. . of Public Health Service, Proceedings of Medical and Surgical Section 7 . Committee on Nominations Dr. D. B. Moss (Chairman), Chief Medical and Surgical Officer, Chicago, Burlington & Quincy Railroad, Chicago, 111. Dr. Duncan Eve, Jr., Chief Surgeon, Nashville, Chattanooga & St. Louis Railway, Nashville, Tenn. Dr. A. W. Ide, Chief Surgeon, Northern Pacific Railway, St. Paul, Minn. Dr. S. C. Plummer, Chief Surgeon, Chicago, Rock Island ik Pacific Railway, Chicago, 111. Dr. S. B. Taylor, Chief Surgeon, New York Central Railroad, Columbus, 0. Committee on Occupational Diseases and Rehabilitation Dr. O. B. Zeinert (Chairman), Chief Surgeon, Missouri Pacific Railroad, St. Louis, Mo. Dr. G. W. Cale, Jr., Chief Surgeon, St. Louis Southwestern Railway, Tex arkana, Ark. Dr. J. G. Frost, Chief Surgeon, Chicago & Eastern Illinois Railway, Chicago, 111. Dr. D. B. Moss, Chief Medical and Surgical Officer, Chicago, Burlington & Quincy Railroad, Chicago, 111. Dr. F. E. Smith, Chief Surgeon, Wabash Railway, St. Louis, Mo. Representative from Committee of Direction Dr. J. R. Garner, Chief Surgeon, Western Railway of Alabama, Atlanta, Ga. Committee on Developments Resulting from Physical Examinations Dr. S. B, Taylor (Chairman), Chief Surgeon, New York Central Railroad, Ooiumbus, 0. Dr. W. N. Blount, Chief Surgeon, Gulf, Mobile & Northern Railroad, Laurel, Miss. Dr. J. C. I.andenberger, Chief Surgeon, Oregon Short Line Railroad, Salt Lake City, Utah. Dr. J. F. Roe, Chief Surgeon, Denver & Rio Grande Western Railroad, Denver, Colo. Dr. II. D. Sykes, Asst, to Medical and Surgical Director, Baltimore & Ohio Railroad, Baltimore, Md. Representative from Committee of Direction Dr. Harvey Bartle, Chief Medical Examiner, Pennsylvania Railroad, Phila delphia, Pa. Committee on Extension of Use of Standard First-Aid Packer Dr. T. R. Crowder (Chairman), Director, Department of Sanitation and Surgery, Pullman Company, Chicago, III. s American Railway Association Dr. J. D. Collins, Chief Surgeon, Seal ward Air Line Railway, Norfolk, Va. Dr. A. M. Hume, Chief Surgeon, Ann Arbor Railroad, Owosso, Mich. Dr. A. W. Ide, Chief Surgeon, Northern Pacific Railway, St. Paul, Minn. Dr. F. H. MeNaught, Chief Surgeon, Colorado & Southern Railway, Denver, Colo. Representative from Committee of Direction Dr. G. G. Dowdall, Chief Surgeon, Illinois Central System; Chicago, 111. Joint Committee on Railway Sanitation (Medical and Surgical Section Representatives) Dr. T. R. Crowder, Director, Department of Sanitation and Surgery, Pullman Company, Chicago, 111. Dr. ,1. Prank Dinneu, Chief Surgeon, Erie Railroad, Cleveland, Ohio. I)r. D. B. Moss, Chief Medical and Surgical Officer, Chicago, Burlington & Quincy Railroad, Chicago, 111. (Engineering Division Representatives) R. C. Bardwell (Chairman), Superintendent Water Supply, Chesapeake & Ohio Railway, Richmond, Va. A. B. Pierce, Engineer Water Supply, Southern Railway System, Washing ton, D. C. 11. IV. Vanilovenberg, Sanitary Engineer, St. Louis-South Western Railway, Texarkana, Ark. (Mechanical Division Representatives) R. L. Kleine, Assistant Chief of Motive Power, Pennsylvania Railroad, Philadelphia, Pa. E. P. Moses, Engineer, Rolling Stock, New York Central Railroad, New York, N. Y. John Purcell, Assistant to Vice-President, Atchison, Topeka & Santa Ee Railway, Chicago, 111. (United States Public Health Service Representatives) L. M. Fisher, Sanitary Engineer in Charge, lnt. San. Dist. No. 1, United States Public Health Service, Sub-Treasury Building, New York, N. V. A. P. Miller, Assoc. Sun. Eng., Int. San. Dist. No. 2, United States Public Health Service, 3 "B" St., S. E., Washington, D. C. R. E. Tarbett, Assoc. San. Eng., United States Public Health Service, Wash ington, D. C. (Canadian Health Department Representative) G. H. Ferguson, Chief Sanitary Engineer, Dept, of Pensions and National Health, Elgin Bldg., Ottawa, Canada. Dr. S. C. P Pacific. 1 Dr. II. A. Be Dr. Duncan Railway Dr. C. C. C Texas. Dr. A. R. : Rai! rotti. Dr. Donald I (I x .f m ' . KMaoe-m Proceedings of Medical and Surgical Section 9 Committee on Fractures Dr. S. C. Plummer (Chairman), Chief S u r g e o n , Chicago, Rock Island & Pacific Railway, Chicago, 111. Dr. H. A. Beady, Chief Burgeon, Canadian Pacific Railway, Toronto, Canada. Dr. Duncan Eve, Jr., Chief Surgeon, Nashville, Chattanooga & St. Louis Railway, Nashville, Tenn. Dr. C. C. Green, Chief Surgeon, Texas & New Orleans Railroad, Houston, Texas. Dr. A. R. Metz, Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Railroad, Chicago, 111. Representative from Committee of Direction Dr. Donald Guthrie, Chief Surgeon, Lehigh Valiev Railroad, Sayre, Pa. UtU; ' vi 10 American Railway Association DIVISION I--OPERATING MEDICAL AND SURGICAL SECTION REGULATIONS Representatives 1. Representatives of members or associate members shall be Chief Sur geons or other officials engaged in a similar capacity. They shall be officially designated by the members or associate members they represent. 2. Affiliated members may be appointed by the Committee of Direction. Officers 3. The officers of the Section ahull be a Chairman, a First Vice-Chairman and a Second Vice-Chairman. Committee of Direction 4. There shall be a Committee of Direction which shall consist of 10 repre sentatives of members or associate members within the Section, including the Chairman, the First Vice-Chairman and Second Vice-Chairman of the Section, the past Chairman last holding office ami 0 other representatives of members. The Committee shall, in addition, include in its membership the SurgeonGeneral of the United States Bureau of Public Health Service or a representa tive to be designated by him, aad a representative to be designated by the Conference of State and Provincial Health Authorities of North America. 5. The Committee of Direction shall conduct the business of the Section, authorize, order, define duties, determine the number of and appoint members of such committees that may be necessary to properly conduct the work of the Section. 0. Regular meetings of the Committee of Direction shall be held semi annually, the date and place to be decided by the Chairman. Special meet ings of the Committee may be held at the call of the Chairman. 7. The Chairman of the Section shall act as the Chairman of the Com mittee of Direction. In the absence of the Chairman his duties shall devolve upon the First Vice-Chairman. In the absence of both the Chairman and the First Vice-Chairman, the Second Vice-Chairman shall preside. Should the Chairman and both Vice-Chairmen be absent, the members shall elect a Chairman pro tem. Committee on Nominations 8. There shall be a Committee on Nominations to consist of five representa tives of members or associate members not officers of the Section. 9. As eandi Direction shal elected. The ship on the C mittee. 10. The Ci! select the nam bers as candii Chairman am represents ivi mittee of Drn 11. Any re annual meetii tion such rep been endorse members. 12. The re officers or im votes, shall o 13. The Ci iority ballot at which the Committee o shall be elect 1 3 members ol ing in 1924 t subsequent a 14. The el and Commit designated r election of of be retaken. 15. A voi< roll-call or lu the Chairma shall be tale Association, 1G. Meet', such commi has been iss Annual m place to be > be held at t b ilion IN G SECTION embers shall be Chief Surity. They shall be officially hey represent. Committee of Direction. nan, a First Vice-Chairman c:hshall consist of 10 reproi the Section, including the ce-Chuirman of the Section, opresentatives of members, membership the Surgeonilth Service or a represen fa re to be designated by the ties of North America, he business of the Section, )er of and appoint members rly conduct the work of the action shall be held SemiChairman. Special meetlie Chairman. lie Chairman of the Com mit his duties shall devolve f both the Chairman and aan shall preside. Should the member.? shall elect a ns >consist of five reprsenta i t the Section. Proceedings of Medical and Surgical Section 11 9. As candidates for the Committee on Nominations, the Committee of Direction shall select the names of ten representatives, five of whom shall be elected. The candidate receiving the greatest number of votes for member ship on the Committee on Nominations shall act as Chairman of that Com mittee. 10. The Committee on Nominations shall, prior to the annual meeting, select the names of two or more representatives of members or associate mem bers as candidates for Chairman, two or more as candidates for First ViceChairman and two or more as candidates for Second Vice-Chairman, and 6 representatives of members or associate members as candidates for the Com mittee of Direction. 11. Any representative of a member or associate members may, at the annual meeting, nominate for officers or members of the Committee of Direc tion such representatives as desired, provided that such nominations have been endorsed in writing by ten representatives of members or associate members. 12. The representatives of members or associate members nominated for officers or for the Committee of Direction receiving the highest number of votes, shall be considered elected. Election Id. The Chairman and Vice-Chairmen shall be elected annually by a ma jority ballot ami shall hold office for one year or until the close of the session at which their successors are elected. The term of office of members of the Committee of Direction shall be two years and 3 members of the Committee shall be elected annually. To provide for the inauguration of the foregoing, 3 members of the Committee of Direction shah be elected at the annual meet ing in 1924 to serve for one year and 3 members to serve for two years. At subsequent annual sessions 3 members shall be elected to serve for two years. 11. The election of officers and members of the Committee of Direction and Commit tee on Nominations shall bo by printed ballot and only officially designated representatives shall be entitled to vote. When a ballot for election of officers or members of committees results in a tie such ballot must be retaken. 15. A vote in sessions of the Section may be taken viva voce, by rising, by roll-call or by ballot. If there is any doubt as to the result of a viva voce vote the Chairman can order, or on the request of three members, a roll-call vote shall be taken in accordance with the practice of the American Railway Association, based on the number of memberships held by each member. Meetings of Committees 16. Meetings of any committee may be held at the call of the Chairman of such committee unless for some special reason notification to the contrary has been issued by the Chairman of the Section. Annual meeting of the Section shall be held in May or June, the time and place to be designated by the Committee of Direction. Special meetings may be held at the call of the Committee of Direction. 12 American Railway Association 17. If a member of a committee if* absent from two consecutive regularly called meetings of the committee, his membership ceases ipso facto, and the Committee of Direction shall act as in a vacancy from any' other cause. 18. Should a vacancy' occur in the officers of the Section, the Committee of Direction or Committee on Nominations, the Committee of Direction is authorised to appoint, a representative to fill such vacancy until the next annual meeting. General 19. The right to hold office, vote and attend executive sessions shalMte vested in representatives of members or associate members only. 20. An executive session of the Section may' be held at the call of the Chair man of the Section or ut the request of five representatives of members. 21. These Regulations may he amended by a majority vote at any regular or special meeting of the Section, subject to approval by two-thirds of the voting members by a letter ballot. ! ;jj The follow i I Ann Arboi K r Atlantic Con> f'1i; Baiiimore A Bangor A Ac Canadian V 1 l !1 Chesapeake Chicago A h Chicago A V Chicago A > Chicago, Bu Chicago, lia Chicago, Ho Colorado A Elgin, Julio Erie 1\. U. Georgia ft- ' Grand True Great Non' Illinois Com Lehigh Val!- Louisville A Missotni I'.. Nashville,<' New York l New York. Ne1'1'' J on: Northern 1 t; dation om two consecutive regularly hip ceases ipso facto, arid the v from any other cause, f the Section, the Committee le Committee of Direction is such vacancy until the next 1 1 executive sessions ghall be members only. held at the call of rhe Chairtentatives of members, majority vote at any regular tproviil by two-thirds of the P ru rcalu itjs of Medical and Suiical S ection 13 MEDICAL AND SURGICAL SECTION Pennsylvania'Hotel, New York, N. Y., June 13-14, 1932. The followin; ; representatives were present: M em bers Representatives , . ,, t> .......... A. M. Hume, Chief hurgn. AAntlnanAtircboCloKas.tKL.i.n..e...R. R..................... .... ..E. A. Dru..m.. , AM1 e..0d0iCc. .ah. 1lieEftvxnaMrmneindeicral Ex- Baltimore & Eastern R. R ............... ... Iarvey Bartle aminer. Bangor & Aroostook R. K.... _ .... ........ H. C. Bundy, Chief Surgeon. Canadian National Rys.... ........... ..... ..John McComhe, Chief Medical Officer. K. E. Dowd, Asst, to Chief Medical Officer. ....H. A. Beatty, Chief Surgeon and Canadian Pacifie Ry................. ..... Medical Officer. ....J. Frank Dinnen, Chief Surgeon. Chesapeake & Ohio Ry...---- ------- .....1, G. Frost, Chief Surgeon. Chicago & Eastern Illinois Ry--.... CChhiiccaaggoo && IIlllliinnooiiss rM.niudilaanndu Ry._. _____Don Deal, Chief Surgeon. Chicago & North Western Ry......... ....C. \V. Hopkins, Chief Surgeon. Chicago, Burlington & Quincy R. R....D. B. Moss, Chief Medical and Surgi cal Offiier. Chicago, Rock Island & Gulf R y ___ S. C. Plummer, Chief Surgeon. Chicago, Rock Gland & Pacific Ry__S. C. Plummer, Chief Surgeon. Colorado & Southern Ry. __________F. H. McNaught, Chief Surgeon. Elgin, Joliet & Eastern Ry..... .............0. G. Davis, Chief Surgeon. Erie R. R .............................................J. Frank Dinnen, Chief Surgeon. Georgia R. R.................................. ..... J. R. Gamer, Chief Surgeon. Grand Trunk Ry. ................................ John McComhe, Chief Aledieal Officer. Great Northern Ry...... ........................K. C. Webb, Chief Surgeon. Illinois Central Sysrem______ ___ __G. G. Dowdall, Chief Surgeon. Lehigh Valley IL R ...............................Donald Guthrie, Chief Surgeon. Louisville V Nashville R. R--- .Duncan EPve., Jr.,. District Surgeon Misssoounrni rPaacriofuic- R. Ra........ ....................O. B. Zeinert, Chief Surgeon, Nashville.Chattanooga. & St.Louis Ry.Duncan Eve, Jr., Chief Surgeon. New York Central lanes....... ..............W, Louis Hartman, Medical Director, L. A. Ensminger, Chief Surgeon. S. B. Taylor, Chief Surgeon. Frank V. Whiting; General Claims Attorney. H. A. Fathauer, Asst. Chief Claim Agent. New York, Chicago & St. Louis R. R ...J. Frank Dinnen, Chief Surgeon. New York, Ontario & Western Ry......J. B. Huietf, Chief Surgeon. Northern Pacific Ry. ................. ........... A. W. Lie, Chief Surgeon. 14 American Railway Association Ohio River & Western Ry.___............... Harvey Bartle, Chief Medical Ex aminer. Pennsylvania II. R ............................... Harvey Bartle, Chief Medical Ex aminer. Quincy, Omaha & Kansas City R. R...D. B. Moss, Chief Medical and Surgi cal Officer. Reading Ry. System....... ..... .............F. S. Ferris, Chief Medical Examiner. Rutland R. R ......................... ............. S. W. Hammond, Chief Surgeon. The Twelfth American Railv, City, at ten oV St. Joseph & Grand Island Ry............ J. R. Nilsson, Chief Surgeon. St. Louis-San Francisco Ry................. R. A. Woolsey, Chief Surgeon. Seaboard Air Line Ry.............. ............J. D. Collins, Chief Surgeon. South Brooklyn Ry.............................. R. H. Carr, Medical Director. Tennessee Central Ry____ __ ______ Duncan Eve, Jr., District Surgeon. Toledo, Peoria & Western R. R __ ....R. A. Hanna, Chief Surgeon. Union Pacific R. R .......................... ...J. It. Nilsson, Chief Surgeon. J. D. Shingle, District Surgeon. Virginian Ry............ ................. ........ ...Southgate Leigh, Chief Surgeon. Wabash Ry...........................................F. E. Smith, Chief Surgeon. Western Maryland Ry........ ................. F. C. Warring, Medical Examiner. Western Ry. of Alabama........ ....... ..... J. R. Garner, Chief Surgeon. West Jersey & Seashore R. R............... Harvey Bartle, Chief Medical Ex aminer. also Tne Cri.uKM The first nan I have no prep Committee of 1 for the splerulii this time to ex: aits' when 1 v. a 1 happy to say 1a if 1 mu very >o 1 Rom him, " ' 1 "Tomygic 3 next Viorai '1 the Corme i Packets." 1 DPrre.sGideeonrtgeAiC; to attend our Abbott Chemical Company..... ............J. F. Biehn, Director. |j compel- him to American Railway Association.............J. C, Caviston, Secretary (M. <fc S. u) WemiU now Section). "Pott's Fraeiu H. J. Forster, Secretary and Treasurer. of New York. Beckman Street and Stuyvesani Square Hospitals...... ..... ............................... R. H. Kennedy, Attending Surgeon. D r . C lay R , Columbia University College of Phy moment this i sicians and Surgeons .........................F. W. Bancroft, Associate Professor of farmer who we. tfet Clinical Surgery. C. R. Murray, Assistant Professor of during tire rail hill his truck b r Surgery. he could do vr Sa ft'. International Journal of Medicine arrd load it up agu V Surgery................................ .............F. E. Lewis, M. D., Editor. market, unktu, of his produce the case his tri If st his truck, a t v ' and said, "Su Ly. It seems th; unit which wt *f:tv motion pietur moving pictu This quest' &r; l' ay : discussed value to presented published calling at examined fanners, Of these of tiervou vascular abnormal cular par: I D r. P . B. M obb (A cting C k a irm a n ), C hief D r. G . W . Culc, J r., C hief ftu rj'ro n , S t. Louis- M edical and Surgical Oilicer, C hicago, SouihweHiern Railway. diagnosis report, w miuee to B u rlin g to n <b I Q am c y XtuilroaU. D r. !'. E . ,S m ith , C hief S u rg eo n , V a b a s h ; ])r. O. lb Zcinert, C hief burgeon, M issouri R ailw ay. Pacific `R ailroad. Section Representative of Commhlct' of D iu ctio n D r. .1. R . G a rn e r, C hief S urgeon, The W estern R ailw ay of A labam a and Georgia R ailroad. -------------------- Recom \ 1. In i following New York, N. Y., April 30, 1932. ` 2. \Y To the Medical and Surgical .Section: Beginning with this year, the designation of this Committee was changed from that of "Occupational Diseases and Hazards" to that of "Occupational Diseases and Rehabilitation." fc: An informal meet ing of the Committee was held at Toronto on September 22, h 1931, and tentative plans for the year's work were mapped out. Dr. W. H. Bolmrt was appointed Chairman. Following this meeting, as you no doubt know, Dr. Bohart became ill, and because of his illness, meetings of the Committee were delayed so that actually there has been but one formal Committee meeting---that of April 12, 1932, in Chicago, though there was an informal meeting of the Committee in Chicago on January 14, 1932, to make plans for the year. Because of this situation, the Committee has not 5. ' had the time or the opportunity to give more than a limited consideration to size, eq knee re: r prims or at lea.evidence ably Vie for exai 3. Ai syphili1 4. Oi lesion proper conside subjects embrace.d under the new title of the Committee, and for that reason to sue it is thought that it might be helpful to offer a recapitulation of the more propel important mutters already considered by the Committee and reported upon. e. r Syphilis genera respoi: A very live topic of the Committee has been that of syphilis among railway be, abl employes. In looking over the Proceedings of the Section, we find that when this Committee was appointed in 1921 with Dr. Ensminger as Chairman, this question of syphilis was of first importance, and during the intervening years has been the most important topic considered by the Committee and should In in tra j| j Ac 1 ition ISEASES argeon, S t. Louis- Surgeon, Wabash pril 3, 1932. ee was changed t "Occupational hi September 22, uit. Dr. \V. H. ing, as you no ess, meetings of , hut one formal rough there was ary 11, 1932, to mmittee has not consideration to J for that reason lion of the more d reported upon. is among railway e find that when :;er as Chairman, g the intervening e Committee and Proceedings of Medical and Surgical Section 53 discussed by the Section, and without doubt the discussion has been of a value to the railroads which cannot be overestimated. This matter wag presented forcefully to the attention of the Chief Surgeons through a paper published by Stokes and Brehmer, of the Mayo Clinic, about ten years ago, calling attention to their record that 11.7 per cent of railroad employes examined at the Clinic had syphilis, contrasted with 1.5 per cent among farmers, 3.8 per cent among business men and (S.l per cent among laborers. Of these syphilitic railroad employes mentioned, 79 per cent had evidence of nervous system involvement, while 18 per cent had evidence of cardio vascular syphilis. The evidence of nervous system involvement was pupillary abnormalities, fundus changes, disturbed reflexes, inco-ordination and mus cular paralysis. " Sixty-four per cent of those presenting clinical or laboratory diagnostic evidence of syphilis had positive spinal fluids. This exhaustive report, which was corroborated by other investigators, influenced your Com mittee to make very definite recommendations, which were discussed by the Section and favorably received. Recommendations: 1. In making examinations, either pre-employment or service, note the following for eye changes reaction of pupils to light and accommodation, size, equality, irregularity, fundus changes, muscular paralysis. Note gait, knee reflexes, Romberg, extended arms for tremors, general adenitis. 2. When an applicant for employment on being examined is found to have a primary lesion or other evidence of recent infection, he should be rejected, or at least approval postponed until such time as he shall be able to exhibit evidence that he has received sufficient and proper treatment and may reason ably be thought cured; if he then be accepted, he should be required to report for examination and observation at least annually. 3. An applicant for employment who exhibits any of the signs of late syphilis should be rejected. 4. On periodical service examination, an employe found to have a primary lesion should be temporarily removed from service and required to undergo proper treatment, not being permitted to resume service until he can be considered safe. 5. Those employes manifesting late syphilis hut not having progressed to such a stage as to threaten a calamity may be continued in service under proper treatment and observation. 6. Those already having progressed to a state that, locomotor ataxia or general paresis is inevitable, should be removed from train service or other responsible or hazardous occupations and assigned to such work as they may be able to do and where they will be free from danger to themselves or others. 7. Those already hopelessly involved and a menace to themselves or others should be retired. In 1928, the Committee recommended that all applicants for employment in train or allied service should be required, in addition to the regular examina- m. 1 " Y'"'; s-:" Proceedings J tion prescribed, to have a blood test made, and a positive reaction should be considered a cause for rejection. Your Committee holds to the opinion that QRS complexes in all derivedio serious conditions with which this is a recommendation which deserves to be emphasized, and urges that it be made a routine by all roads examining applicants for employment, particularly in engine, train and switching service. ciated with mitral regurgitation uncomplicated mitral regurgit&i fibrillation associated with mi per cent, while uncomplicated i Cardiovascular-Renal Disease Cardiovascular-renal disease received its first, consideration when the Committee in 1925 addressed a questionnaire to a number of well-known internists, whose replies may be epitomized into the following: No definite rules can be set out whereby a deadline can be drawn; employes must be considered individually. But in general, when there is complaint of shortness of breath on exertion, when there is marked acceleration of the heart rate after exercise, which does not return to its resting rate after two or three minutes of rest, or is persistently above a rate of 90 at rest, when the blood pressure does not elevate in a normal way after exercise and within a .. * ; f ' 1 t J I ; He further reports that of 117 j tion I, 78, or 66.1 per cent, hav 33 patients still alive, 10 rep' unchanged. Of 52 patients h: and II, 35, or 67.3 per cent, hat In another group with a T iv has been a mortality of 50 per The Committee has reports the assistance which may Ire d. in selected cases. five minute period returns to a point below the previously resting point, when there are arhvthmias of various sorts intensified by exercise, when the examiner Hypertension, whether it 1> observes signs of inadequate heart function, such as hurried breathing, cough 1 hypertension on an arteriosc' on exertion, cyanosis, slight edema of dependent parts, all signs pointing to j Chief Surgeons, who are respu a pending decompensation, serious consideration should be given to 8ueh an 1 element in the operation of cu individual's fitness to remain in engine, train or switching service. Given in hypertension are the ability an employe presenting such symptoms associated with a hypertension, a acter of the cerebral vessels, kidney impairment evidenced by an albuminuria, casts, and reduced PSP factors, hypertension would r t less than 35 per cent to 40 per cent in two hours, an organic heart lesion, i sudden disablement under corn: particularly a mitral stenosis, or evidence of an aortic lesion, especially when j tell us that about 14.3 per com g - associated with syphilis, warrants a recommendation that such employe j accidents and 7.3 per cent of should be removed from engine, train or switching service, and should not. ; f and terminate with tragic sun be returned to duty until there has been a marked improvement. An employe j ! may be determined by labor: I with a fibrillating auricle, a bundle branch block or a heart block is unfit \ j gives definite prognostic evirr ts for this class of service. i j which should not be ignored. Dr. Frederick A. Willius, of the Mayo Clinic, presents some statistics on : Because of the unknown far the electrocardiographic study of various heart lesions, which are illuminating hypertension, the Committee and important to the Chief Surgeon in his attempt to decide whether an engaged in train service who he. employe can with safety be continued in service. In a series of 500 cases and below 200 systolic, with a of auricular fibrillation, Dr. Willius reports a mortality of 41.3 per cent in kept under observation. The I four years, while in a similar number of cases of heart lesions of various types . ] diastolic above 120 should bl without fibrillation, there is a cardiac mortality of 13.6 per cent. Auricular and should be returned to ser !;Iv fibrillation with abnormal QRS complexes in all derivations of the electro Y'our present Committee wisln cardiogram has a mortality of 63.4 per cent, while a control series with this recommendation. :r. abnormal QRS complexes in all derivations without auricular fibrillation has a mortality of 54.2 per cent. In another series of auricular fibrillation with i abnormal QRS complexes in all Leads and ventricular premature contractions Diabetes is another conditio there is a cardiac mortality of 87.5 per cent. A control series of abnormal Committee in recent years, QRS complexes in all derivations with ventricular premature contractions internists, from whose replies has the same mortality, 87.5 per cent. From a prognostic standpoint, abnormal considered a hazard in railway Proceedings of Medical and Surgical Section QRS complexes in all derivations of the electrocardiogram is one of the most serious conditions with which we have to deal. Auricular fibrillation asso ciated with mitral regurgitation has a cardiac mortality of 51.9 per cent, while uncomplicated mitral regurgitation has a mortality of 27.8 per cent. Auricular fibrillation associated with mitral stenosis has a cardiac mortality of 47.1 per cent, while uncomplicated mitral stenosis ha3 a mortality of 22.2 per cent. He further reports that of 117 patients having a T wave negativity in Deriva tion I, 78, or 66.1 per cent, have died within a period of four and a half years; 33 patients still alive, 10 reporting their condition worse, 15 improved, 8 unchanged. Of 52 patients having a T wave negativity in Derivations I and II, 35, or 67.3 per cent, have died within a period of four and a half years. In another group with a T wave negativity in all three derivations there has been a mortality of 50 per cent in the same four and a half year period. The Committee has reported these statistics to bring to your attention the assistance which may be derived from resorting to the electrocardiograph in selected cases. Hypertension Hypertension, whether it be of the type of essential hypertension or a hypertension on an arteriosclerotic basis, is of outstanding importance to Chief Surgeons, who are responsible for efficiency and safety of the human element in the operation of our railroads. The unknown factors operating in hypertension are the ability of the heart muscle to carry on and the char acter af the cerebral vessels. Couid some way be devised to measure these factors, hypertension would cease to be the problem which it is, because sudden disablement under conditions of risk could then be avoided. Statistics tell us that about 14.3 per cent of those having a hypertension die of cerebral accidents and 7.3 per cent of angina pectoris, either of which may develop and terminate with tragic suddenness. A diminution in renal function, as may be determined by laboratory tests, adds to the gravity of the case, and gives definite prognostic evidence, fundus changes also furnish evidence which should not be ignored. Because of the unknown factors in the production and progress of arterial hypertension, the Committee has heretofore recommended that employes engaged in train service who have a persistent hypertension above 175 systolic and below 200 systolic, with a diastolic above 100 and below 120, should be kept under observation. Those having a persistent systolic above 200 or a diastolic above 120 should be removed from service pending investigation, and should be returned to service only after showing definite improvement. Your present Committee wishes to affirm and emphasize the importance of this recommendation. Diabetes Diabetes is another condition which lias been exhaustively studied by your Committee in recent years. Letters of inquiry were addressed to leading internists, from whose replies it was deduced that diabetes per se was not considered a hazard in railway service. The replies were all to the effect that 56 American Railway Association Pro. the diabetic would probably break down physically or have developed some < disease which would incapacitate before he would become a hazard because ! Is it required that of his diabetes. However, the predominant opinion of these same men was : one eye, or who has h to the effect that a diabetic faking insulin should not be employed in a hazar- j ible with ordinary let: dous occupation, for the reason that a hypermsulinaemia is a real menace. . j the good eye to be or Your Committee recommended that a diabetic taking insulin should not be I is necessary? continued in a hazardous occupation whereby he might be injured or cause j injury to others through becoming incapacitated suddenly. This recom- i mendation has not met with the unanimous approval of the Section, but ? your present Committee desires to affirm the wisdom of that recommendation. \ It is conservative, and directed toward the promotion of safety. j l Number answers* Number answer Number answer Number answers Number answers . Non-Shatteiable Spectacles orGoggles 11 Nun'ilrer answer i \ lost an eye. Number ausweri On February 16, 1932, the Committee forwarded Circular M. & S. 135 to j if condition is seventy-seven class one railroads having Chief Surgeons to ascertain their t are nor. rospo; f: practice in connection withthe wearing of goggles. Thequestions asked in j Number answer : L this circular letter as well as a summary of the replies received, are shown ! Number answer! below: ; i Question No. 1 a i Is the wearing of spectacles or goggles of non-brcakable glass mandatory in certain occupations? Number answering "Yes"..................................................................62 Number answering "No".................................................................. 11 Following page si Os calcis treated on class of accidents, the heights to the ground In two patients be The period of dis, Question No. 1 b quite satisfactory an usual occupations, If so, in what occupations required? the duties of their Practically all of the 69 railroads answering the questionnaire indicated in their replies that the practice as to requiring the use of goggles in certain occupations was quite uniform. Some roads stated they were required by "Shopmen;" others by "Mechanical Department;" others by "M. of W. men cutting rail;" others "In all eye-hazardous work;" others "when Chipping, fc Grinding, Welding, Babbitting, Cutting Rivets, etc." of the femur or tibia employes will be fun the spine except or vertabra; but will dr These cases were handle special fract IS. Question No. 2 Is an employe who has lost one eye continued in service? h Number answering"Yes in some capacities".. 28 . . j Number answering"Yes"._............................................22 f Number answering"Not in Train or EngineService"..11 : Number answering"Not as a Rule".............. 7 h Number answering"No"............................................... 4 Number answering "Have had no such case"..... ........................... 1 ffer: mt.-;Y t L Proceedings of Medical and Surgical Section 57 Question No. 3 Is it required that the employe who through accident or disease has lost one eye, or who has had the vision in one eye much impaired and not eorrectible with ordinary lens, shall wear glasses or goggles, the lens, which protects the good eye to be of non-breakable glass, ground to a correction when that ia necessary? Number answering "Yes"................................................................. 32 Number answering "No"........... -................................................ ..... 27 Number answering "Yes in some instances"................................... 2 Number answering "Have had no such case"....................-............. 2 Number answering "Each case handled on merits".... ............. ...... 2 Number answering "Same rule applies as to man tvho has not lost an eye.... ................... ............................................................... 1 Number answering "If injured in service, but taken out of service if condition is discovered and found due to injury for which we are not responsible, especially in train service"......................... 1 Number answering "Do not provide or require prescription lenses".. 1 Number answering "Not yet practice but believe good idea"......... 1 Fractured Os Caleis Following page shows in detail a series of ten (10) cases of fractures of Os caleis treated on one railrbad during 1930 and 1931. As is usual in this class of accidents, the injuries are sustained by falling or jumping from unusual heights to the ground. In two patients both heels were fractured. The period of disability is uniformly long, however, the end results were quite satisfactory and the majority of employes were enabled to resume their usual occupations. Those who were permanently incapacitated to perform the duties of their former employment, presented defects due to fractures of the femur or tibia and fibula as complicating factors. The tatter class of employes will be furnished light work. All cases escaped serious injury to the spine except one, who received fracture (compressed) of first lumbar vertabra; but will doubtless resume his usual work. These cases were given attention by Surgeons particularly qualified to handle special fractures and dislocations. ^merica/t Railway Association O ccu p atio n . M anner of Infliction of In ju ry FRACTURED OS CALCIS C haracter of Injury Period of D isability .End Results H o stle r...... ................................. C a r R ep a irer.... ........................ B ra k e m a n .................................. M a c h in ist............ ...................... M aintenance of W ay D e partm ent. M a c h in is t........ ..................... S w itc h m a n ................................ T ru c k D riv e r .................... ...... B . & B. C a rp e n te r .......... ...... C a r R e p a ire r.-.................. ...... Jum ped from standing en gine. Jum ped from moving train.. W hile on tra in in m otion, foot lipped off caboose and stru ck end of tie. Fell from stan d in g engine.... Fell from house roof, dis tance S feet. Fell from stan d in g engine.... F ell fro m to p of b o x c a r...... S tum bled and fell on sidew alk . Fell from broken scaffold, distance 20 feet. F e ll off s ta n d in g b o x c a r...... C om m inuted fracture Os calcis extending into Subastragular joint. F ra c tu re rig h t and left Os calcis. F r a c tu r e 0 $ calcis.................. 4 m o n th s.................................... 1? m o n th s ................................... 14 m o n th s ................................... Perm anent deform ity and broken down arch. Resumed usual em ploym ent. No perm anent features; resum ed w ork. No perm anent features; resum ed work. F ra c tu re Os calcis an d Astra g u lu s . Last exam ination 4 m onths after accident. R estriction of lateral m ovem ents. W ill be able to resum e usual work. F r a c tu r e Os ca lcis.................. L a s t e x a m in a tio n D ec. 1, N o p e rm a n e n t featu res. W ill be mno. able to resum e usual work. F r a c tu r e Os c a lc is ..-............. 6 m o n th s ..................................... N o p e rm a n e n t fe a tu re s. R esu m e d usual work. C om m inuted fracture Os calcis; fractu re of F em ur. 10 m o u th s.. ............... ................ P erm anently disabled for y ard serv ice a c c o u n t f r a c tu re of Fem ur. Os calcis satisfactory. C o m m in u te d fra c tu re Os 3 m o n th s ...................... ............... N o p e rm a n e n t featu res. R esu m e d calcis. usual work. F ra c tu re Os calcis; fracture com pressed first lum bar vertebra. Last exam ination 5 m onths after accident. R estricted m ovem ent of an k le b u t will be able to resum e usual work. F ractu re Os calcis rig h t and -Recent ac cid en t a n d still No p erm an en t feature., acco u n t left; fracture of fem ur; under observation Os calcis.. b u t is p e rm a n e n tly d is fracture of Tibia and abled as car repairer on account F ib u la . fracture of fem ur and tibia and ffbula. <-*- r4- O ^ Z' O rp- O rP4 ftS' P ft i--( -- 2L a -- Os CCTPC --ft- cor o cn oP m j cfrtj p % c O hrj g pJ- c*T. ccK; P P 5 Cw cV+- O p CCP 2 O rT O p, P O' f* C ^ Ooe ft o -< m r-. .-r P 7C; -- --------- r ^ Vit 1L-X-.-.t3-. V v t c ^ i u ^ i - : i ^ t J * i t e j i ,;>ii?iVV/.,:' ; * <u Z-2 ^ 8** *-*"CJ Tt_3i o x <-> z-s> * t *1.0 t5 Ul trt 1 I ! s J i3 ? 5'3 i % >a w t'o +>Soi 3 S t u y 1 m V 2'3 M e ! -2 1 > = 2 i A3 US es o 15 iu 3 35 i"3 a I I o^ Proceedings of Medical and Surgical Section 59 - ! Lumbago J This subject under the caption `'Painful backs" is included in the report of Committee in its report of April 28, 1931, at which time further considera tion was given to this subject under "Foci of infection." There is little to add except to mention general infections as causative factors as for example, colds, influenza, sore throat, gonorrhea, etc. Exposure in wet or damp clothes may also be followed by lumbago. Traumatic lumbago itself depends upon more or less extensive lesion to the ligaments or muscles or to some other of the structures which are in relation with the vertebrae. From the anatomy of the spinal column it is obvious that these injuries may result from sudden twists or wrenches of the spine or may occur through blows or falls on the back or through lifting heavy weights. The symptoms appear soon after the injury, though it is several days before they reach their maximum intensity. *:* The chief characteristic of the condition and indeed the one which is the basis 5 for most of the others, is pain in the back. The duration of traumatic lumbago is variable; but if the condition is not accompanied by complications such as Hypertrophic arthritis or other chronic afflictions, the intensity of the pain on movement rapidly decreases and the period of disability usually does not exceed three to four weeks. Employes who because of their occupations are subjected to frequent attacks of lumbago resulting in temporary disability should be given employment if available, requiring no lifting of heavy weights or occupations necessitating unusual muscular exertion. ft should be emphasized that when X-ray examinations of the spine are made, that antero-posterior and lateral views be taken. \ Spondylolisthesis This condition as demonstrated by X-ray examinations is an anterior and downward displacement of the body of the fifth lumbar vertebra in relation I! with the sacrum. It is the contention of many observers that the condition should be regarded as a congenital defect; however, in alleged injury cases I it may be difficult to exclude traumatism as a direct cause of the condition or in aggravating the pre-existing defect. A case of spondylolisthesis has recently been reported by one road. The condition was caused by a fall, the patient striking upon the buttocks, and which was immediately followed by pain in sacrococcygeal region, very severe in character, movements of back not restricted when admitted to hospital. He made an uneventful recovery with the exception of the, displace ment of vertebra. It was decided that owing to the latter condition which is permanent, he should not be permitted to" perform work in hazardous occupations. Sacroiliac .Disease Sacroiliac sprain or disease may be considered under the general classifica tion of ``Low Back Pain" since its symptomatology :'i the main is referred to the lumbosacral region. The Committee desires to emphasize the fact that "S i ?  CO American Railway Association it is only through a careful history of the case in connection with a critical examination assisted by every- laboratory means that the etiology may' be; worked out and a correct diagnosis finally arrived at. The bugaboo of industry today is the sacroiliac sprain, first described lry Goldthwait; it is fast assuming the same importance in claims and litigation as the "railway- spine" of a generation ago. Da Costa, in "Modern Surgery," states that a fall, lifting a heavy weight, a blow, a twist, or long continued standing, bending, lying or sitting may cause a sacroiliac sprain. We wish to emphasize particularly "lying" as a cause. Whenever so many ridiculous reasons are given as a cause for a complaint which is wholly subjective, well may we pause to con sider whether there is in fact any basis for assuming a sacroiliac sprain as a distinct entity. The Committee does not deny the existence of sacroiliac pain in occasional patients, but we hold that it is not of frequent occurrence, and the foci of infection which give rise to it may frequently be determined if diligently sought for. We believe that a diagnosis of sacroiliac sprain is too frequently made and on insufficient foundation. Consider, if you will, the anatomy of the sacroiliac union. It is a true joint, because the contiguous surfaces of the sacrum and ilium are covered with cartilage, yet so intimately bound together through cartilaginous union throughout the joint, surface as well as the strong ligaments externally as to constitute almost one bone--the strongest joint in the body--and ordinarily the only' change which takes place in this joint throughout life is in the pregnant woman, which is a physiological process. T r e a t m e n t : Besides searching out and eradicating foci of infection, the commonly' accepted treatment in these conditions of painful backs is rest, administration of antirheumatic remedies, diathermy, massage, and support, either by properly applied adhesive strap or belt correctly adjusted. Operative procedures may be considered in obstinate cases. The Committee urges as a routine practice, early and satisfactory' X-ray films, both anteroposterior and lateral, in every case of complaint of back pain following an injury, and a searching quiz for history of previous com plaints of pain in the back, as being the only way- in which the interests of our companies may be properly safeguarded. It will be a surprise also how frequently lateral X-ray films of the spine will reveal evidence of a fractured vertebra when least suspected, and where an anteroposterior reveals no evidence of an injury. Dust As An Industrial Hazard Dusts may be industrial hazards in three ways; first, some produce injuries by igniting, burning and exploding, as coal dust and dust, of grain elevators and grain mills; second, some produce systematic poisoning by inhalation, ingestion and absorption, as the salts of mercury, lead and arsenic; third, some, though non-poisonous, produce lung pathology when inhaled, and these constitute the most usual health hazard. All lung pathology caused by inhalation of dust is known as Pneumo coniosis, and this is the hazard I wish to emphasize. The terms silicosis, Proceedings anthracosis, siderosis, etc., dusts from specific materials lung pathology' but so far si: Dust pathology may oecu inhaled in sufficient quant i certain conditions it occurs i The pathology of pneurn lodges in the small alveoli o of fibrosis begins and biocku of these lymph spaces in oi continued dust inhalation hi until even an entire lobe r and symmetrical. For the purpose of desert and Third Stages. In the fi health is good except for a shortness of breath on oxer occasional pleurisy pain, examination is negative to X-ray' shows a definite in fibrous tissue. In the second stage the nodular, more of the lymp frame work of the lungs u and exertion causes a defn with little expectoration, quent-ly and capacity for expansion is decreased. >' pleura and consolidation, inspiration and expiration but dry cracking rales nu increased fibrosis t,brought caused by tiffing up of tl Distribution of this fibre more thickened than in I In the third stage the fibrosis and large nodule are a very marked shorn) of expectoration (if expei infection), persistent pie Physical examination rev breathing being almost e. sistent, and cyanosis pr< infection no moist rales increase in the fibrous t the appearance of a sno Proceedings of Medical and Surgical Section 01 anthracosis, siderosis, etc., are used to designate the pathology caused by dusts from specific materials as silica, coal and iron. Many dusts may cause lung pathology but so far silica (Si2) has been found to be tile most harmful. Dust pathology may occur in any occupation where dust is produced and inhaled in sufficient quantity over a long enough period of time. Under certain conditions it occurs in from one to two years or at any time thereafter. The pathology of pneumoconiosis is that of fibrosis. Wherever the dust lodges in the small alveoli of the lungs it sets up an irritation and the process of fibrosis begins and blocking of the lymphatics in that area occurs. Blocking of these lymph spaces in one area increases the burden of another and with continued dust inhalation and blocking of spaces, the iibrotic process increases until even an entire lobe may be consolidated. This condition is bilateral and symmetrical. For the purpose of description pneumoconiosis is divided into First, Second and Third Stages. In the first stage the symptoms are few, usually the general health is good except for a tendency for frequent chest colds, there is a slight shortness of breath on exertion, practically no cough or expectoration, and an occasional pleurisy pain. The capacity for work is not decreased. Physical examination is negative except for slight roughening of the breath sounds. X-ray shows a definite increase in the lung shadows due to the increased fibrous tissue. In the second stage the fibrosis has increased and the lung tissue becomes nodular, more of the lymphatic spaces have been blocked and the interstitial frame work of the lungs is thickened. The symptoms are, more pronounced and exertion causes a definite shortness of breath, there is an irritative cough with little expectoration, bronchial colds and pleurisy pains occur more fre quently and capacity for work is decreased. On physical examination chest expansion is decreased. On percussion there is a dullness due to thickened pleura and consolidation, breath sounds are decreased in volume and both inspiration and expiration are sharper than normal. No moist rales are heard but dry cracking rales may be heard in the lungs and throat. X-ray shows increased fibrosis throughout the lung, the fibrosis and increased density being caused by filling up of the small lung spaces with lymphatic tissue deposit. Distribution of this fibrosis i3 equal through both lungs and the pleura is more thickened than in the first stage. In the third stage the patient presents himself with an advanced diffuse fibrosis and large nodular areas throughout the lung fields. The symptoms are a very marked shortness of breath, persistent cough with a small amount of expectoration (if expectoration is profuse it usually is due to intercurrent infection), persistent pleurisy pains, loss of weight and inability to work. Physical examination reveals a rigid chest wall with practically no expansion, breathing being almost entirely diaphragmatic, shortness of breath being per sistent, and cyanosis present at times. Unless there has been intercurrent infection no moist rales are heard in this stage. The X-ray shows a marked increase in the fibrous tissue and large nodular areas, giving the lung field the appearance of a snow storm which is characteristic of this stage. '-'a s v 62 Am erican Railn'ay Asnociation In the first stage the heart is normal in appearance but as the fibrous tissue increases it is pulled toward the right side until in the third stage it often occupies a vertical position in the thorax. Dust inhalation renders the hinge susceptible to intercurrent infection and tuberculosis is often superimposed, particularly in the second and third stages. The distinguishing features between pneumoconiosis and tuberculosis are', pneumoconiosis shows no elevation of temperature, unproductive cough, no loss of weight until the late stage, sputum negative, X-ray shows bilateral and symmetrical involvement, all lobes affected, apices usually clear with no lung cavities. Tuberculosis shows an elevation of temperature, productive cough, loss of weight, sputum often positive for tubercular bacilli, X-ray shows more often unilateral or non-symmetrical involvement, apices or upper lobes are usually first affected and cavitation may occur. Dust pathology of the lungs can be prevented in two ways, first, by the adequate and proper use of water to wet down the dust at the point of its origin; second, by forced ventilation to quickly remove the dust particles and replace this with clear air. After definite involvement of the lungs has taken place curative measures are limited. In the. first stage if the paticut is removed from the dusty atmos phere, some dust excretion occurs, and a limited improvement takes place and the fibrosis becomes arrested, and capacity for work is not limited. In the second stage after removal from the dusty air the pathology becomes stationary, the general health improves, but shortness of breath and limited capacity for work remain. In the third stage after removal from dusty air very little improvement occurs as the pathology is too extensive and usually secondary infection has taken place. Capacity for work is extremely limited or absent, and treatment is symptomatic only. In conclusion we wish to emphasize the facts that under certain conditions inhalation of dusts causes a fibrosis of the lungs known as pneumoconiosis and that this is an industrial health hazard, that it can be prevented by proper use of water and ventilation, that after fibrosis develops secondary infection is prone to occur and tuberculosis is often engrafted on the fibrosis, and the radiographic examination is the easiest and most reliable means of diagnosis. Respectfully submitted, C o m m it t e e o k O c c u p a t io n a l D is e a s e s a n d R e h a b il it a t io n , D. B. Moss, M. D., Acting Chairman. Dr. P lummer: Mr. Chairman: You will notice the report is made by the: Acting Chairman. It states in the beginning of the report that the Chairman of this committee, Dr. Bohart, became ill. The latest report we have, of Dr. Bohart is that he is no better, and the prospect- of his ever being with us again is poor. I would like to make a motion that the Chairman and the Secretary formu late a message, to be transmitted to him, letting him know we are thinking of him while he is unable to be with us at the meeting. Procct'i D r . D owdall: I ! The motion was put ' (The Secretary aeeon Dr. W. H. Bohart, Vero Beach, Fla, Medical and Suiy and best wishes. A Dit. D o w d a l l : 1 n Diseases and Rehabilit: . . . . The motion \ T h e C h a ir m a n : A s me that it would be both is the report of the S Periodic Physical E.vnn (Dr. S. B" Taylor heM. & S. 140 ns follows: ft as i Proceedings of Medical and Surgical Section 63 D r. D owdall: I second the motion and suggest it be a telegram. The motion was put to a vote anil carried. (The Secretary accordingly wired Dr. Hobart as follows:) New York, June 14, 1932. Dr. W. H. Bohart, Vero Beach, Fla. Medical and Surgical Section in Convention assembled sends greetings and best wishes. We all miss you. (Sgd.) J. C. Caviston, Secretary." '-d D r . D o w d a l l : I move the report of she Committee on Occupational Diseases and Rehabilitation be accepted as a progress report. . . . . The motion was seconded by Dr. Taylor, put to a vote and carried. 'J! T h e C h a ir m a n : A s the hour is growing short 1 believe you will agree with me that it would be better to proceed to the next number on the program, which $ is the report of the Special Committee on Developments Resulting from Periodic Physical Examinations. Dr. S. B. Taylor, Chairman. (Dr. S. B. Taylor here presented the report of his committee, per Circular * M. & S. 140 as follows:) :>] :,3 b V.L