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FILE NAME: Railroads (RR) DATE: 1936 June DOC#: RR005 DOCUMENT DESCRIPTION: Proceedings of the 19th Annual Meeting of the Medical and Surgical Section - American Railway Association r y v J b ijy r r ^ o c & ia a O & i a -^ .. . , .......................... ,.. ,, .................. ; ^ > r v V f. ; . i,* *l.v .. ................ Association of American Railroads * rg>tirttwtW.uri.imB,iBail::il'l',jlri' r n ii" ",, u rirru i vviuaotoiitttuitilM at* ^^ V i ff ?*s * %-< ft f , * 'V-V "- ' S' * ' ' - P R O CEED IN G S r| i :. , " OF THE nineteenth1 annjai, meeting ... ................. ....................... T f 'y ; - . O f TH ^ t f MEDICAI. AND SURGKAL SECtlOW V v * '" V - **V * V * S < r i ^ * \ ^ *. ^ y .V v' i * T? r. 0 1V . * ^jC a*-1' .'' *'H"' X,`/``N* 7 t . -i - s r y w H T fEisa^? ^ . . , ^ ; , \ * 4 V41 *h h 4 i P ; W v 5 ^ / ^ -n* - . & >** V , * ,<y i '*&1 i&%@*C*"A?*. >.`4v"JM-VA 'i ' S,f*>v ^hAAi at?1 ; S ? ` . , / '`> 4 * fr*"4 ^ ft>T S ^ t - f S r i i T '-i -..-- 'K ^ C J i P R O C E E D IN G S OF THE NINETEENTH A N N U A L MEETING OF THE Association of American Railroads M ED ICA L A N D SU RG ICA L SECTION HELD AT STEVENS HOTEL, CHICAGO, ILL. JUNE 15-16, 1939 E astern P rinting C orporation New York, N. Y. 1939 V\v , t; \ ' . \ -' <c 1': O--' '"' l- V", i / * - - ^ r v ' ^ i W j r f . ^ v ^ ' i ^ : i i t j 'l* t : r i ^ ^ :-;<}/K V f,^^^w <.,iv 'ri>'i.-'*'s';,i.' i f i w;. ji^ i- IN D E X Page Association of American Railroads. Board of Directors..... ....._.............................................................. .............................. 5 Officers.-............................................................................................................................ 5 Operations and Maintenance Department................................................. 6 Operating-Transportation Division: officers............................................................... 0 Ballot for members of committee of direction.......................................................................... 78 Bnrtle. Harvey: discussion on common colds and cardio-v&scular-rcnal diseaee.......... 43-45 Remarks as incoming chairman........................... ........................................ -.............. 125 Beatty, H. A.: discussion on first-aid organization........................................................... 80, 90 Boufflcur, A. I.: discussion on first-aid requirements................ ................................... . 90, 91 Callender, ,J. W.: address relative applications for annuities under Railroad Retire ment Act.............................................................................. .................................. 53-59, 00 Committee (special) on medical aspects of air conditioning of cars................................ 8 Report of............................................................................................. 63-76 Committee of direction.......................................................................................................... 6, 7 Report of (included in chairman's remarks) - - .......................................................... 17-19 Committee on disability and rehabilitation........................................................................ 7 Report of.......................................................................................................................... 29-43 Committee on fractures......................................................................................................... 7 Report of.......................................................................................................................... 93-99 Supplemental report..................................... .................................................................. 100,101 Committee on developments resulting from physical examinations.................. 7 Report of..................... 80-84 Committee on nominations: report of................................................................................ 77, 78 Crowder, T. R.: report as chairman, committee on medical aspects of air conditioning of cars.-....................................................................................... Dinnen, J. Frank: remarks on developments from pre-employment examinations..... 63-76 85 Election of members of committee of direction.................................................................. 78, 112 Ensminger, L. A.: report as chairman, committee on nominations..... ........................... 77, 78 Eve, Duncan: address as chairman...................................................................................... 17-19 Remarks on fractures of the neck of the femur and ankle.--................................... 102-105 Gamer, J. R,: report as chairman, committee on disability and rehabilitation.-.......... 29-43 Hansen, T. L.: discussion of fractures of the spine.-......................................................... 109-112 Remarks on fractures around the ankle joint............................................................. 119-121 Henry, R. S.: remarks of-- ................................................................................................... 61, 62 Ide, A. W.: discussion of pneumonoconiosis--............................................ ...................... 45-47 Lancaster, W. J.: remarks on common colds...................................................................... 49 Lynch, M. E.: address on Railroad Retirement Acts.......................... .. .......................... 50-52 McCombe, John: discussion of first-aid organization.-..... ---------------------------------- 88, 89 lSS^^HaaB6iaiK!laSii!iK^[i^ --, * Page ........................... ................................... .......................................... 6 6-8 13-15 .......................................... eC .M .St.P.& P.R .R . 9-12 85,86 - ......................................... 90,91 ........................................ 118,119 iopments resulting from .................................... sosi ........................................ 117 *-....................-....-..... 86-88 ..........................105-109, 121, 122 il reference to railroad ........................................ 19-27 ................. 17 ...................... (il 9 > .... .............. <v> -JO's .............. oo in j olving the knee .......................113-116, 117, US .................... 47 4Q f the os calci8" (illus- 122-125 I % ir 4 1 3 ? ASSOCIATION OF AMERICAN RAILROADS Officers J. J. Pelley, President R. V. Fletcher, Vice-President and General Counsel (Law Department) --------------------- , Vice-President (Operations and Maintenance Department) A. F. Cleveland, Vice-President (Traffic Department) E. H. Bunnell, Vice-President (Finance, Accounting, Taxation and Valuation Department) H. J. Forster, Secretary-Treasurer Board of Directors J. J. Pelley, Chairman (ex-officio). Ralph Budd, President, Chicago, Burlington & Quincy Railroad. M. W. Clement, President, Pennsylvania Railroad Company. C. E. Denney, President, Erie Railroad Company. E. M. Durham, Jr., Chief Executive Officer, Chicago, Rock Island & Pacific Railway. Geo. B. Elliott, President, Atlantic Coast Line Railroad Company. E. J. Engel, President and Chairman of Executive Committee, Atchison, Topeka & Santa Fe Railway. E. S. French, President and Chairman, Executive Committee, Boston & Maine Railroad and Maine Central Railroad Company. J. B. Hill, President, Louisville & Nashville Railroad. W. M. Jeffers, President, Union Pacific Railroad. D. J. Kerr, President, Lehigh Valley Railroad. J. M. Kurn, Trustee, St. Louis-San Francisco Railway. Ernest E. Norris, President, Southern Railway System. L. R. Powell, Jr., Receiver, Seaboard Air Line Railway. H. A. Scandrett, Trustee, Chicago, Milwaukee, St. Paul & Pacific Railroad. Daniel Upthegrove, Chief Executive Officer, St. Louis Southwestern Railway. Daniel Willard, President, Baltimore & Ohio Railroad Company. F. E. Williamson, President, New York Central System. t WM INDEX--Continued Medical and Surgical Section: Page Officers.......................................................................................... ................................... 6 Personnel of committees........._...................................................................................... 6-8 Representatives attending annual meeting....- ............................................................ 13-15 Rules of order... - ............................................................................................................ 9-12 Meta, A. R.: remarks on results of physical examinations on the C. M. St. P. & P. R. R. 85, 86 Remarks relative first-aid package....__........................................................................ 90, 91 Remarks on fractures.-................................................................................. ................. 118, 119 Meyers, Geo. P.: report as chairman, committee on developments resulting from physical examinations............................................................................................ 80-81 Remarks on fractures --................................-........................................................... 117 Nilsson, J. R.: discussion on pamphlet on first-aid instructions...................................... 86-88 Discussion on open reduction of fractures.....................................................105-109, 121, 122 Russell, Albert E .: address on "Syphilis control with special reference to railroad employes''...... 19-27 Sessions of annual meeting: Thursday morning, June 15........ 17-60 Thursday afternoon, June 15...-.... - .............................................................................. 61-92 Friday morning, June 16--............................................................................................. 92-125 Webb, R. C.: presentation of report of committee on fractures....................................... 92-101 Discussion of fractures of the upper end of the tibia involving the knee joint................................................ ................ ........ ................................. 113-116, 117, 118 Woolsey, R. A,: discussion on rehabilitation...................................................................... 47-49 Yoerg, O. W.: address on "A treatm ent for acute fractures of the os calcia'' (illus trated by moving pictures).................................................................................. 122-125 ASSOCIATION OF / J. J. Pelley, President R. V. Fletcher, Vice-President and -- ---------------- , Vice-President (O A. F. Cleveland, Vice-President (T E. H. Bunnell, Vice-President (Fin Department) H. J. Forster, Secretary-Treasurer Board J. J. Pelley, Chairman (ex-officio). Ralph Budd, President, Chicago, B M. W. Clement, President, Ponnsy C. E. Denney, President, Erie Rail E. M. Durham, Jr., Chief Executd Railway. Geo. B. Elliott, President, Atlantic E. J. Engei, President and Chair Topeka & Santa Fe Railway. E. S. French, President and Chairm Railroad and Maine Central 11 J. B. Hill, President, Louisville & ' W. M. Jeffers, President, Union Pa D. J. Kerr, President, Lehigh Valle J. M. Kurn, Trustee, St. Louis-San Ernest E. Norris, President, Souths L. R. Powell, Jr., Receiver, Seaboa H. A. Scandrett, Trustee, Chicago, Daniel Upthegrove, Chief Executiv Daniel Willard, President, Baltimo F. E. Williamson, President, New ' 1L (i'.'J*>ji_* "f mviam Association of American Railroads OPERATIONS AND MAINTENANCE DEPARTMENT ------------------------, 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. Harvey Bartle, Chairman Dr. W. J. Lancaster, Vice-Chairman J. C. Caviston, Secretary MEMBERS OF COMMITTEES Committee of Direction (Term Expires in 1940) Dr. Harvey Bartle (Chairman), Chief Medical Officer, Pennsylvania Railroad, Philadelphia, Pa. Dr. W. J. Lancaster* (Vice-Chairman), Superintendent and Medical Director, Relief Department, Atlantic Coast Line Railroad, Wilmington, N. C. Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga & St. Louis Railway, Nashville, Tenn. Dr. E. V. Milholland, Medical and Surgical Director, Baltimore & Ohio Rail road, Baltimore, Md. Dr. O. B. Zeincrt, Chief Surgeon, Missouri Pacific Railroad, St. Louis, Mo. (Term Expires in 1941) Dr. A. W. Ide, Chief Surgeon, Northern Pacific Railway, St. Paul, Minn. Dr. A. R. Metz, Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Rail road, Chicago, 111. 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 as member of Committee of Direction expires in 1941. Proceedings < 1 Dr. A. J. Chesley, SecretaryHealth Authorities of No Dr. Thomas Parran, Jr., Surge Washington, D. C. STANDING COM Committee o Dr. J. R. Garner (Chairman) Atlanta, Ga. Dr. G. I. Jones, Chief Surgeor Dr. John McCombe, Chief ' Montreal, Canada. Dr. R. A. Woolsey, Chief Surg Reprsentatif Dr. W. J. Lancaster, Superin ment, Atlantic Coast Lin Coi Dr. B. L. Coley (Chairman), New York, N. Y. Dr. J. D. Collins, Chief Surge Dr. T. L. Hansen, Chief Sun Chicago, 111. Dr. Wm. Hibbitts, Chief Sui Texarkana, Ark. Dr. O. B. Zeinert, Chief Surgi Reprsentatif ----------------------------- (Vacai Committee on Developnr Dr. G. P. Myers (Chairman), Detroit, Mich. Dr. Don Deal, Chief Surgeon, 111. Dr. D. E. Remsberg, Assistar and Pension Department Dr. R. A. Woolsey, Chief Surg Mo. Reprsentatif Dr. A. R. Metz, Chief Surgeo road, Chicago, 111. M -rrv Proceedings o/ Medical and Surgical Section 7 Honorary Members Dr. A. J. Chesley, Secretary-Treasurer, Conference of State and Provincial H ealth Authorities of North America, St. Paul, Minn. Dr. Thomas Parran, Jr., Surgeon General, Bureau of the Public Health Service, Washington, D. C. STANDING COMMITTEES AS OF JUNE 17, 1939 Committee on Disability and Rehabilitation Dr. J. R. Garner (Chairman), Chief Surgeon, Western Railway of Alabama, A tlanta, Ga. Dr. G. I. Jones, Chi^f Surgeon, Southern Railway System, Washington, D. C. Dr. John McCombe, Chief Medical Officer, Canadian National Railways, Montreal, Canada. I)r. R. A. Woolsev, Chief Surgeon, St. Louis-San Francisco Rv., St. Louis, Mo. Representative from Committee of Direction Dr. W. J. Lancaster, Superintendent and Medical Director, Relief Depart ment, Atlantic Coast Line Railroad, Wilmington, N. C. Committee on Fractures Dr. B. L. Coley (Chairman), Chief Surgeon, New' York Central Railroad, New York, N. Y. Dr. J. D. Collins, Chief Surgeon, Seaboard Air Line Railway, Norfolk, Va. Dr. T. L. Hansen, Chief Surgeon, Chicago, Rock Island & Pacific Railway, Chicago, 111. Dr. Wm. Hibbitts, Chief Surgeon, St. Louis Southwestern Railway Lines, Texarkana, Ark. Dr. O. B. Zeinert, Chief Surgeon, Missouri Pacific Railroad, St. Louis, Mo. Representative from Committee of Direction ------------------------------ (Vacancy). Committee on Developments Resulting from Physical Examinations Dr. G. P. Mj'ers (Chairman), Medical Director, New York Central System, Detroit, Mich. Dr. Don Deal, Chief Surgeon, Chicago & Illinois Midland Railway, Springfield, 111. Dr. D. E. Remsberg, Assistant Superintendent and Medical Director, Relief and Pension Department, Norfolk & Western Railway, Roanoke, Va. Dr. R. A. Woolsey, Chief Surgeon, St. Louis-San Francisco Railway, St. Louis, Mo. Representative from Committee of Direction Dr. A. R. Metz, Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Rail road, Chicago, HI. 8 Association of American Railroads Committee on Medical Aspects of Air Conditioning of Cars Dr. T. R. Crowder (Chairman), Director, Department of Sanitation and Surgery, Pullman Company, Chicago, 111. Dr. E. V. Milholland, Medical and Surgical Director, Baltimore & Ohio Railroad, Baltimore, Md. Dr. R. S. Yancey, Medical Director, Missouri-Kansas-Texas Lines, Sedalia, Mo. Representative from Committee of Direction ---------(Vacancy). Proceed A S S O C IA T ^O r* DIVISION 1 MEDI 1. REPRESENTATIC representation of membi Chief Surgeons or other Express Agency, Inc., an in this Section. 2. AFFILIATED ME! collaborating or coopera her thereof upon the appr An affiliated member sh; road representative, ex 3. The officers of the and Secretary. (a) As provided VICE-CHAIRMAN its membership. Th not succeed himself. (b) The SECRET the Division. His s the approval of tin partment. (c) The COMMI' hers, territorially Xew England and C four from the W estserve for three years The terms of off Direction shall expir in the committee me mittee until the nexi In addition to th Bureau of Public II< him, and a represent Provincial Health Ac of the Committee of Proceedings of Medical and Surgical Section 9 ASSOCIATION OF AMERICAN RAILROADS DIVISION I--OPERATING-TRANSPORTATION MEDICAL AND SURGICAL SECTION RULES OF ORDER 1. REPRESENTATION: As provided in the Plan of Organization, the representation of member roads: in the 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 in this Section. 2. AFFILIATED MEMBERS: A representative of an organization collaborating or cooperating with the Section may become an nilibated 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 th a t 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 E ast; 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 Provincial Health Authorities of North America shall be honorary members of the C om m ittee of D irection. 10 Association of 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 affairs 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 th at 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 a t the annual meeting the nomina tions contained in th at 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 th a t official. Proceedings of 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 a t 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 th at year, and to fill any vacancy. The duties of the Standing Committees shall be as follows: 9. COM M ITTEE 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. COM M ITTEE 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. COM M ITTEE 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 w'ell as the forms used in connection therewith. 12. COM M ITTEE 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 partm ents 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. 12 Association of American Railroads 15. ORDER OF BUSINESS: The order of business a t 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. I Railroads of business a t meetings of the isjority of the members present ting le proceedings of this Section, Proceedings of Medical and Surgical Section 13 MEDICAL AND SURGICAL SECTION Stevens Hotel, Chicago, 111., June 15-16, 1939 The following representatives were present: Members Representatives Alton R. R ................................................E. V. Milholland, Medical and Surgical Director. Ann Arbor R. R.......................................A. M. Hume, Chief Surgeon. Atlanta & West Point R. R ...................J. R. Garner, Chief Surgeon. Atlantic Coast Line R. R ....................,W . J. Lancaster, Superintendent and Medical Director, Relief Departmen t . Atchison, Topeka & Santa Fe R y........ M. L. Bishoff, Chief Surgeon. Baltimore & Ohio, Chicago Terminal R. R ......-................................................E. V. Milholland, Medical and Surgical Director. Baltimore & Ohio R. R ....................... ...E. V. Milholland, Medical and Surgical Director. Belt Ry. Co. of Chicago......................... J. G. Frost, Chief Surgeon. A. B. Dickey, General Claim Agent, Bessemer & Lake Erie R. R .................. R. W. Brown, Chief Surgeon. Canadian Rational Rys..........................John McCombe, Chief Medical Officer. A. J. Gilchrist, in charge of Treatment and Examinations. Canadian Pacific Ry............................... H. A. Beatty, Chief Surgeon and Medical Officer. Chesapeake & Ohio Ry.......................... J. Frank Dinnen, Supervising Surgeon. J. J. Brandabur, Assistant Supervising Surgeon. Chicago & Eastern Illinois Ry.............. J. G. Frost, Chief Surgeon. J. F. Lord, Assistant to General Manager. D. J. Sheehan, Superintendent of Motive Power. A. R. Swanson, Chief Claim Agent, Chicago & Western Indiana R. R ........ J. G. Frost, Chief Surgeon. Chicago, Burlington & Quincy R. R ....0 . H. Horrall, Chief Surgeon. R. B. Kepner, Medical Officer. D. B. Moss, Chief Surgeon (Retired). J. T. Williamson, Supt. Relief and Employment Departments. "Chicago Heights Terminal Transfer R. R ......................................................A. R. Swanson, Chief Claim Agent. Chicago, Milwaukee, St. Paul & Pacific R. R .......................................................A. R. Metz, Chief Surgeon. A. I. Bouffleur, Chief Surgeon, Lines West. ___________ O. W. Yoerg, Surgeon. Associate Member. 14 Association of American Railroads Chicago, Rock Island & Pacific R y...... T. L. Hansen, Chief Surgeon. Colorado & Southern Ry...................... L. H. Wade, Chief Surgeon. Denver & Rio Grande Western R. R.... G. H. Curfman, Chief Surgeon. R. S. Allison, Assistant Chief Surgeon. Erie R. R.................................................. J. Frank Dinnen, Chief Surgeon. J. W. Houk, Asst, to Chief Surgeon. Georgia R. R............................................J. R. Garner, Chief Surgeon. Great Northern Ry................................. R. C. Webb, Chief Surgeon. Gulf, Colorado & Santa Fe Ry............. O. F. Gober, Chief Physician. Gulf, Mobile & Northern R. R.......... C. H. Ramsay, Chief Surgeon. Illinois Central System.......................... G. G. Dowdall, Chief Surgeon. Illinois Terminal R. R........................... It. M. Sutton, Chief Surgeon. Louisville Nashville R. R.................. Duncan Eve, Division Surgeon. Missouri Pacific R. R.......................... .0. B. Zeinert, Chief Surgeon. Nashville, Chattanooga & St. Louis R y..........................................................Duncan Eve, Chief Surgeon. New York Central System.................... G. P. Myers, Medical Director. L. A. Ensminger, Chief Surgeon. C. F. Stineman, Chief Claim Agent. H. A. Fathauer, Assistant Chief Claim Agent. New York, Chicago & St. Louis R. R.... J. M. Dinnen, Chief Surgeon. J. Frank Dinnen, Assistant Chief Surgeon. J. W. Houk, Assistant to Chief Surgeon. Norfolk & W'estern Ry........................... D. E. Remsberg, Assistant Superin tendent and Medical Director. Northern Pacific Ry............................... A. W. Ide, Chief Surgeon, Eastern Division. Pennsylvania Railroad........................... Harvey Bartle, Chief Medical Ex aminer. Walter Aye, Medical Examiner. I, . L. Cooper, Oculist. J. W. Harper, Medical Examiner. H. E. Heston, Medical Examiner. C. R. Houchins, Secretary to Chief Medical Examiner. I. eRoy S. Howard, Medical Examiner. S. W. Hurst, Medical Examiner. A. P. Isenberg, Company Surgeon and Medical Examiner. T. B. L. Jordan, Company Surgeon and Medical Examiner. R. C. Kell, Neuropsychiatrist. J. S. Moses, Medical Examiner. J. E. Nickel, Medical Examiner. R. D. Saul, Medical Examiner. J. A. White, Medical Examiner. Pennsylvania-Reading Seashore Lines.A. P. Isenberg, Company Surgeon and Medical Examiner. Proceedings of Peoria & Pekin Union Ry. Pullman Company............ Railway Express Agency, IncReading Company............. ........ St. Louis-San Francisco Ry...... St. Louis Southwestern Ry........ Seaboard Air Line Ry................ Staten Island Rapid Transit Ry. Southern Pacific Co.--Pacific L Southern Railway System.......... Texas & New Orleans R. R....... `Toledo Terminal R. R.............. Union Pacific R. R...................... Wabash Ry................................... Western Maryland Ry......... Western Railway of Alabama.... Association of American Railroai Railroad Retirement Board. United States Public Health Scr University of Illinois........... ......... * Associate Member. 'nericati Railroads Proceedings of Medical and Surgical Section 29 -rtainly have enjoyed listening to your ink you on behalf of the membership. I be the Report of the Committee on bairman, Dr. Garner, who is the Chief M A S SO C IA T IO N (Circular M. & S. 206) OF AMERICAN R A ILR O A D S his Committee's Report and emphaeovered. . . . MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION ])r. J. R. Garner {Chairman). Chief Surgeon, A. A W. K R. R., W. Ry. of Ala., Georgia Railroad. Dr. Glenn J. Jones, Chief Surgeon, Southern Railway System. Dr. John McCorabe, Chief Medical Officer* Canadian National Railways. Dr. R. A. Woolsey, Chief Surgeon, St. LouisSan Francisco Railway. Representative of Committee of Direction Dr. W. Lancaster, Superintendent & Medical Director Relief Department, Atlantic Coast Line Railroad. N e w Y o r k , N. Y., May 19, 1939. To th e M edical and S oroical S ec tio n : This Report of your Committee on Disability and Rehabilitation covers its activities for a period of two fiscal years, there having been no annual session of the Medical and Surgical Section held during the )rear 1938. The Committee has held meetings in New York and Chicago and has con ducted a large part of its investigation through correspondence. While your Committee, a t this time, presents some subjects not heretofore re ported upon it feels th a t the major subjects previously investigated and brought to your attention are of paramount importance, and these subjects are reviewed in the light of more recently acquired data. We therefore invite your con sideration of the following topics; Dysfunction of the Ductless Glands During recent years the Chief Surgeons of several railroads have become interested in the possibilities of endocrine therapy, even to the extent of adding an endocrinologist to the list of their consultants. In order to ascertain the practical usefulness of such medication to railway employees the morbidity figures of a member line, writh an average working force of something over seventy thousand men, have been scrutinized for the year 1938 and enquiries have also been made through various authorities specializing in the field of endocrinology. The result of these investigations has produced two conclusions. On the one hand th at the limitations of the glandular treatm ent are, in the. light of our present knowledge, definitely prescribed and th a t in the ordinary work of industrial or railroad medicine these limitations should not, generally speaking, be exceeded with any expec tation of definite results. On the other hand, laboratory and other experi mental work is proceeding at such a pace th a t definite and valuable additions to endocrine therapy may be expected in the near future. For this reason the following resum of glandular disorders and their treatment, as applicable to railway employees, is presented herewith. Proceedings of Medical and Surgical Section 15 Peoria & Pekin Union Ry......................J. E. Meloy, Chief Surgeon. Pullman Company.................................. T. R. Crowder, Director, Department of Sanitation and Surgery. R. M. Graham, Chief Medical Ex aminer. Railway Express Agency, Inc.............. E. C. Holmblad, Regional Surgeon. J. W. Titman, Claim Agent. Reading Company...................................F. S. Ferris, Chief Medical Officer. A. Neupauer, Superintendent, Philadelphia-Reading Relief Association. St. Louis-San Francisco R y...................It. A. Woolscy, Chief Surgeon. St. Louis Southwestern Ry....................William Hibbitts, Chief Surgeon. Seaboard Air Line Ry............................J. D. Collins, Chief Surgeon. Staten Island Rapid Transit Ry......... . .E. V. Milholland, Medical and Surgical Director. Southern Pacific Co.--Pacific Lines....C. A. Walker, Chief Surgeon. Southern Railway System..................... G, I. Jones, Chief Surgeon. Texas & New Orleans R. R...................J. L. Taylor, Chief Surgeon. `Toledo Terminal R. I t..........................Tom Brown', Surgeon. N. T. Barnes, Assistant Surgeon. Union Pacific R. R .............. .................. J. It. Nilsson, Chief Surgeon. Wabash Ry.............................................. W. E. Gollings, Superintendent Wabash Hospitals. Western Maryland R y................ .......... F. C. Warring, Senior Chief Resident Surgeon. Western Railway of Alabama............... J. R. Garner, Chief Surgeon. also Association of American Railroads ........R. S. Henry, Assistant to President. J. C. Caviston, Secretary, Medical and Surgical Section. Railroad Retirement Board...................J. W. Callender, Chief, Disability Claims. M. E. Lynch, Director, Retirement Claims. United States Public Health Service ..Albert E. Russell, Surgeon in Charge Syphilis Control in Industry. University of Illinois...............................S. Perry Rogers. Associate Member. 30 Association of American Railroads Within the limits of our present knowledge should be considered the thyroid, pancreas and suprarenal glands, all of which show varying grades of glandular dysfunction in the adult, and to cope with which we have at our disposal definite extracts and substances obtained from these glands for the correction of their deficiencies. Considering the thyroid gland first, we have, of course, the hypo and hyper function of this gland. Hypofunction or myxoedema manifests itself in a general slowing of all body functions, a lowering of the oxygenation of all tissues, namely, a low basal metabolic state. The metabolism test for this deficiency represents a low oxygen utilization by the body tissues and one obtains a minus precentage utilization calculated upon the basis of surface area and body weight and height. In contradistinction to this, the hyper functioning thyroid will show an increase percentage utilization of oxygen calculated in the same manner. The symptoms and signs of a hypofunctioning thyroid will, of course, be increasing body weight, slow pulse or heart rate, low blood pressure, dry and generalized thickening of the skin with oedema, dry falling hair and brittle nails, lethargy, fatigue, sensitivity on exposure to cold, drowsy, sleepy, heavy feeling, a sluggish function of the intestinal tract and inability or lack of ability to generalized body perspirations. The consideration of treatment centers around the degree of hypofunction which exists and this may be determined by a basal metabolic test which will furnish the oxygen utilization. Knowing this, we can proceed to give thyroid extract to make up for the lack of normal secretion. In doing this it is well to remember th at the U.S.P. and the B.P. differ in their standardization of the extract and therefore their potencies differ. The U.S.P. form is some six times stronger than that of the B.P. The hyperfunctioning thyroid will be manifest in the signs and symptoms of an overactive gland function with loss of body weight, irritability, profuse generalized perspirations, nervousness, sleeplessness, loose frequent bowel actions, increased pulse and heart rates, elevated blood pressure with an increase of pulse pressure, moist hot skin of fine velvety texture with flushing, the nails will be soft and pliable and the hair will be oily and moist with a natural sheen. This form of thyroid disturbance requires the administration of iodine in the form of Lugol's Solution in order to help the gland store its normal secre tion, and after obtaining a lowered basal metabolic rate then either surgical removal of part of the gland or X-ray radiation of the gland should be resorted to. The surgical removal or treatm ent by X-ray radiations is necessary to remove some and at times all of this hyperfunctioning glandular tissue, as it will soon take on increased activity again. We should next consider the pancreas and in this we have to deal in the great majority of cases with hypofunction of the gland which results in a defin ite disturbance of the body's sugar metabolism. This will be seen in the signs and symptoms of loss of body weight, lack of energy and strength, nervousness and general irritability, itchiness of the skin, frequency of urination, increased Proceedings of Af thirst and appetite, headaches an of the urine will usually reveal ai evidence of reducing substance fo words, the presence of sugar in the reveal an increase in the sugar cor In the treatment of this pancrei has been prepared as an extract i requires to be given hypodermicall amount of sugar found in the blc has been combined with protamin. tion of the extract, and thereby p sugar circulating in the blood sti individuals because it promotes a into the body and prevents many i suffering from diabetes and this i known as insulin or diabetic con people is the fact th at this form day and thus permits the individui necessity of frequent repetitions from the older form of insulin to 1 clearly understood th at very caref must be made, in order to see wh cessfully or not. More recently clearer concepti formed, and with this one may i and a hypofunction of this gland. The hyperfunctioning suprarer.E sion with paroxysmal or permar headaches and difficulty in metal < tumor formation within the glam bilateral. The treatment of this involved. On the other hand, the case of 1 symptoms of marked fatiguability a great inability to concentrate, i Physical examination reveals a slo pressure not unlike a case of hy will also be foimd to be low. The treatment of this condition extract of the suprarenal gland, a mouth. The latter has been foum pretty clearly demonstrated thai there is a very definite loss of sod within the body. The above fairly well covers o dysfunctions and their treatment. : " '\ .v. -: ' ' JfoX ican Railroads Proceedings of Medical and Surgical Section ige should be considered the thyroid ch show varying grades of glandula ith which we have a t our disposal^ from these glands for the correction lave, of course, the hypo and hypers r myxoedema manifests itself in a f lowering of the oxygenation of all I ate. The metabolism test for this : ition by the body tissues and one .lculated upon the basis of surface 1 >ntradlstinction to this, the hyper- j e percentage utilization of oxygen ffioning thyroid will, of course, be t rate, low blood pressure, dry and "dema, dry falling hair and brittle sure to cold, drowsy, sleepy, heavy nal tract and inability or lack of iround the degree of hypofunction y a basal metabolic test which will iLs, we can proceed to give thyroid cretion. In doing this it is well to Ter in their standardization of the t. The U.S.P. form is some six s : .nifest in the signs and symptoms ; ' body weight, irritability, profuse i eplessness, loose frequent bowel ted blood pressurewith an increase ; elvety texture with flushing, the i l be oily and moist with a natural j s the administration of iodine in i the gland store its normal secreatabolic rate then either surgical m of the gland should be resorted X-ray radiations is necessary to unctioning glandular tissue, as it m I in this we have to deal in the he gland which results in a defin:n. This will be seen in the signs energy and strength, nervousness 'requency of urination, increased thirst and appetite, headaches and frequently ocular disturbance. Analysis of the urine will usually reveal an increased density or specific gravity and evidence of reducing substance for Fehling's or Benedict's Solution, in other words, the presence of sugar in the urine. Chemical analysis of the blood will reveal an increase in the sugar content. In the treatm ent of this pancreatic deficiency we have today insulin which has been prepared as an extract of this gland. Insulin in the original form requires to be given hypodermically several times a day, depending upon the amount, of sugar found in the blood and urine. The newer form of insulin has been combined with protamine zinc, in order to promote a slower absorp tion of the extract, and thereby prevent a too rapid reduction in the ievel of sugar circulating in the blood stream. This is of great assistance to most individuals because it promotes a much slower administration of tile insulin into the body and prevents many acute drops in the blood sugar levels of those suffering from diabetes and this offsets and prevents many of the collapses known as insulin or diabetic coma. Another great advantage to working people is the fact that this form of insulin only requires to be given once a day and thus permits the individual continuing at his employment without the necessity of frequent repetitions of his insulin requirements. In changing from the older form of insulin to the newer protamine zinc form it should be dearly understood th a t very careful observation and study of the blood sugar must be made, in order to see whether the individual can use this form suc cessfully or not. More recently clearer conceptions of the suprarenal function have been formed, and with this one may now' differentiate between a hyperfunction and a hypofunction of this gland. The hyperfunctioning suprarenal gland cases show paroxysms of hyperten sion with paroxysmal or permanent tachycardia, nervousness, irritability, headaches and difficulty in metal concentration. These cases all show definite tumor formation w'itbin the gland which though usually unilateral, may be bilateral. The treatm ent of this condition is surgical removal of the gland involved. On the other hand, the case of hypofunctioning suprarenal show's signs and symptoms of marked fatiguability, weakness, loss of strength and energy and a great inability to concentrate, dizziness and feelings of great unsteadiness. Physical examination reveals a slow pulse, low blood pressure and small pulse pressure not unlike a case of hypothyroidism. The basal metabolic rates will also be found to be low. T he treatm ent of this condition depends upon the use of Cortin, the cortical extract of the suprarenal gland, and the use of ordinary sodium chloride by mouth. The latter has been found of considerable value alone, as it has been pretty clearly demonstrated th a t in this hypofunction of the suprarenals there is a very definite loss of sodium and disturbance of sodium metabolism within the body. The above fairly well covers our present definite knowledge of glandular dysfunctions and their treatment, more particularly as applied to industrial u ,,x v 32 Association of American Railroads and railway employees. The future holds great promise for the successful extension of endocrine therapy and by it to maintaining prolonged energy and fitness for work in ageing employees. Your Committee realizes the difficulty attendant upon compilation of data from already existing records in which specific items may not have been tabu lated and indexed. Chief Surgeons of member lines are therefore requested to maintain full records during the ensuing year of all cases of glandular dysfunc tion coming to their attention and to be prepared, before the next annual meeting, to supply the data requested in a questionnaire, as follows: To what extent have you made use of endocrine therapy during the year 1939-1940. Number of cases treated for thyroid dysfunction: Number of cases treated for pancreatic dysfunction: Number of cases treated for suprarenal dysfunction: Number of cases treated for other form of glandular dysfunction: Results obtained in each category: What is your opinion of the future usefulness of endocrine treatment for industrial workers? Common Colds Our Railroads sustain a tremendous annual loss of time due to disability of employees who have developed th a t form of respiratory infection known as "common colds." This is more noticeable in office employees; due to close proximity, anrl frequent crowding in inadequately ventilated offices, where the infection appears to spread with great rapidity. The prophylaxis of common colds is both hygienic and medicinal. Hygienic measures consist, of: (1) An abundance of fresh air in sleeping quarters, offices or work rooms. (2) Avoidance of sitting directly in drafts. (3) Removal of top coats, wraps, etc., upon entering a warm room. (4) Removal of wet clothing or shoes upon entering the house. (5) When coughing protect others by holding a handkerchief over your mouth and nose. (0) When you have a cold: (a) Reduce amount of exercise. (b) Make sure of proper eliminations. (c) Maintain a nourishing diet. (d) Increase the amount of fluid intake. (7) When you have a cold accompanied by fever go to bed and call your family physician. Medicinal Prophylaxis: (1) Vaccines administered hypodermatically. These have been thought by many to be from 60 to 80 per cent effective in the prevention of colds. The cost, associated with the inconvenience of hypodermic Proceedings injections have pi prophylaxis. (2) Practically the same istration in eithei administered one which one capsul (20) have been ta The Chief Surgeon i and believes to t his employees by tion is less expens attached to hypo to determine the On several past occasions which, in some form or otl: with some real or alleged that of low back pain. Re' of the spine is on the increi and diagnosed. In all ca` toms--either local or mai seeking for and, if possible, as being the true offendinf In our 1937 report yen disorder, which may at ai and constitute a serious i wherein he may constitu .sclerosis, encephalitis, fc cerebral sypliilis were me drug addiction as a habit We cannot emphasize any individual suspeete should not be permitted Recently many Psych Shock" treatment of ro known as " Metrazol" hr following its use. Tim cures. Some physicians are disorder and later havii and safe to resume his m f American Railroads future holds great promise for the successful! ' and by it to maintaining prolonged energy! mployees. J difficulty attendant upon compilation Of d a ta 'l which specific items may not have been tabums of member lines are therefore requested to a ensuing year of all cases of glandular dysfune-J| and to be prepared, before the next annual M uested in a questionnaire, as follows: ade use of endocrine therapy during the year thyroid dysfunction: pancreatic dysfunction : uprarenal dysfunction : tb erform of glandular dysfunction: gory: : future usefulness of endocrine treatment rrmon Colds dous annual loss of time due to disability th a t form of respiratory infection known ioticeable in office employees; due to close in inadequately ventilated offices, where h great rapidity. is both hygienic and medicinal. r sleeping quarters, offices or work rooms. : y in drafts. J is, etc., upon entering a warm room. j shoes upon entering the house. | irs by holding a handkerchief over your -*< 1 cise. im nations, diet. fluid intake. panied by fever go to bed and cull your wmatically. These have been thought ) per cent effective in th e prevention of with the inconvenience of hypodermic Proceedings of Medical and. Surgical Section 33 injections have prevented a more extensive use of this form of prophylaxis. (2) Practically the same bacterial vaccine is now available for oral admin istration in either capsules or enteric coated tablets. These are administered one each morning for a period of seven days, after which one capsule or tablet is taken twice a week, until twenty (20) have been taken in all. The Chief Surgeon of one member line has used this quite extensively and believes to have reduced sickness from common colds among his employees by at least 37H per cent. This form of administra tion is less expensive to the patient and does not hold the antipathy attached to hypodermic injections. A longer study will be required to determine the efficacy of this means of prophylaxis. Chronic Arthritis On several past occasions your attention has been called to chronic arthritis which, in some form or other, constitutes a disability in itself or is associated with some real or alleged injury. Probably the most frequent complaint is that of low back pain. Records seem to indicate that the presence of arthritis of the spine is on the increase, probably it is being more frequently recognized and diagnosed. In all cases of alleged back injury, without definite symp toms--either local or manifest by the X-ruy, we stress the importance of seeking for and, if possible, identifying some distant or obscure foci of infection as being the true offending factor. Mental Disorders In our 1937 report your attention was called to several forms of mental disorder, which may a t any time arise in other apparently healthy individuals and constitute a serious menace if the employee be engaged in an occupation wherein he may constitute a hazard to himself or others. Cerebral arterio sclerosis, encephalitis, following infectious diseases, and the catastrophe of cerebral syphilis were mentioned as diseases productive of metal disorders, and drug addiction as a habit productive of the same ill effects. We cannot emphasize too strongly the importance of a firm handling of any individual suspected to have developed some mental disorder. They should not be permitted to remain in positions of responsibility. Recently many Psychiatrists became enthusiastic over the soealled "Insulin Shock" treatm ent of mental conditions. More recently still, a preparation known as " M etrazol" has come into prominence with the report of many cures following its use. Time alone will prove the permanency of such reported cures. Some physicians are of the opinion th a t a person having suffered a mental disorder and later having been pronounced as recovered therefrom is capable and safe to resume his former occupation. The Psychiatrists, asked for their r ' 15 - ' 34 Association of American Railroads opinioa by members of your Committee, have been, unanimous in the opinion that a person having once suffered from a mental disorder is more prone to recurrence of his aberration, particularly if he returns to the same social, family and business surroundings which existed a t the tim e of his first mental breakdown. For this reason great caution should be exercised in the return ing of such employees to responsible or hazardous occupations. Epilepsy While your Committee has previously reported upon its investigation of epileptics as a hazard in railway industry, a member line has asked for informa tion on this subject. Any person known to have had an epileptic seizure is a hazard in any form of railway train service and should be withheld from all such employment. The fact that the sufferer has never previously had a similar attack is no defense since everything temporal, even epilepsy, must have a beginning. I t is indeed difficult, if not impossible, to diagnose epilepsy in a person not seen during the seizure. In the interim he may appear as a perfectly normal individual. There is a possibility of scars being present on the tongue where this organ has been bitten in the attack, but even this would only be subjective evidence. As a general rule reliance must be placed upon the statements of persons who have seen the sufferer in his seizure and who can accurately describe the manifestations at th a t time. I t has previously been recommended th a t any period of unconsciousness suffered by an employee and not otherwise sufficiently and satisfactorily accounted for should be looked upon as a suspicious case of epilepsy. Syphilis Among railroad employees there can unquestionably be no more important hazard than that constituted by syphilis. Education is now accomplishing much toward convincing the unfortunate syphilitic th at his malady is amenable to treatment if taken in hand in its early stages and treatm ent is persisted in for a sufficiently long period of time. We cannot stress too greatly the importance of impressing syphilitic employees with the fact th at their employment is not to be interfered with if their condition Is not in a stage that would constitute a hazard to others or has not advanced to th at point where there is little hope of controlling and curing their trouble. This, of course,providing they undergo prompt, efficient, and sufficient treatment. They should be kept under regular and frequent observation. Quite obviously there is no place in train and engine service for the neurosyphilitic. In examining railroad employees or applicants for employment, it is more essential to ascertain th a t the party in question does not have syphilis than to learn th a t he does. A relatively low blood test, described as Klein's Test, Proceedings of is reputed to be more effectivi gives assurance th a t the subjeci reaction, the blood should be before a positive diagnosis is r pensiveness of the Ivlcin Test findings, makes it especially a j In 1931 your Committee rr conditions due to employees ' coming into contact w-ith poise At the present time the co into contact with these poise abundant amount of soap and it has penetrated the skin an teristic lesions. As a prevent that laundry soap be applied t in the form of a heavy lather Mo new data relative to th been presented to your Comn consensus of opinion, howevi of tuberculosis shall have be one year before the railroat former duty. While there have been m field, your Committee feels bringing to your attention t to this disease and to the in: It Ls recommended that all their visual acuity at fairly We reiterate our former received from the foremost no diabetic requiring Insul permitted to engage in any pation where he would cons Carr The importance of Card cannot be too greatly stres: a Railroads ve been unanimous in the opinion | mental disorder is more prone to % f he returns to the same social, | [ ted a t the tim e of his first m ental '8? hould be exercised in the return- if rdous occupations. Proceedings of Medical and Surgical Section 35 is reputed to be more effective for this purpose in th a t a negative reaction gives assurance th a t the subject is non-syphilitic. In the presence of a positive reaction, the blood should be checked by the Wassermann and Kahn Test before a positive diagnosis is reached. The ease, rapidity and relative inexpensiveness of the Klein Test, together with its reliability as to negative findings, makes it especially applicable for examination of railway employees. sorted upon its investigation of onber line has asked for informa- seizure is a hazard in any form icid from all such employment. Lsly had a similar attack is no isy, must have a beginning, agnose epilepsy in a person not vy appear as a perfectly normal lg present on the tongue where ;n this would only be subjective placed upon the statements of izure and who can accurately my period of unconsciousness sufficiently and satisfactorily spicious case of epilepsy. d onably be no more important ication is now accomplishing ihilitic th a t his malady' is iarly stages and treatm ent is We cannot stress too greatly i ees with th e fact th a t their mdition is not in a stage th a t ivanced to th a t point where ir trouble. This, of course,sufficient treatment. They iervation. Quite obviously i neurosy'pliilitic. for employ'ment, it is more loes not have syphilis than , described as Klein's Test, Poison Oak In 1931 your Committee made an extensive study of the subject of skin conditions due to employees working upon the roadway and telegraph lines coming into contact with poison oak, poison ivy and similar growths. At the present time the consensus of opinion is th at if the parts coming into contact with these poisonous plants are immediately scrubbed with an abundant amount of soap and water this process will remove the poison before it has penetrated the skin and will prevent the development of the charac teristic lesions. As a preventive against poison oak infection, it is suggested that laundry soap be applied to the exposed parts, such as the arms and hands, in the form of a heavy lather which should be permitted to dry on the skin. Tuberculosis No new data relative to the development or treatm ent of tuberculosis have been presented to your Committee since its last report upon this subject. The consensus of opinion, however, is to the effect th a t all active manifestations of tuberculosis shall have been in abeyance for a period of approximately' one year before the railroad employee should be permitted to resume his former duty. Diabetes While there have been no particularly new developments in the diabetic field, y'our Committee feels th at it should not overlook this opportunity of bringing to your attention the ocular changes w'hich occur in persons subject to this disease and to the insidiousness with which such ocular changes occur. It is recommended th a t all diabetics should be required to stand a test as to their visual acuity at fairly' close intervals. We reiterate our former recommendation, which was based upon advices received from the foremost members of the profession treating diabetes, th at no diabetic requiring Insulin for the control of his sugar output should be permitted to engage in any form of engine or train service, or any other occu pation where he would constitute a hazard to himself or others. Cardio-Vascular-Renal Disease The importance of Cardio-Vascular-Renal Disease in Railroad employees cannot be too greatly stressed. Your Committee feels justified in reiterating i&&Uk 36 Association of American Railroads a portion of its 1936 Report wherein twelve (12) Rules to be applied in the examination of employees were set out. I t was recommended th at the following features should be investigated and evaluated, singly and in conjunction with each other: (1) Blood pressure. (2) Palpation of pulse. (3) Auscultation of heart. (4) Urinalysis, including microscopic. (5) Blood Wassermann. Abnormality to a significant degree in any of the above would disqualify an applicant for employment, and in the case of the reexamination of em ployees, already in service, further examination is recommended, including: (6) X-ray of H eart--Two views, plus fluroscopy. (7) Electrocardiogram. (8) Blood chemistry, especially N.P.N. and blood sugar. (9) Moderate Physical Exertion and Its Effect upon Heart, Pulse, Blood Pressure, M.B.R., etc. In exceptional cases further tests may be needed to complete and confirm the foregoing; in this connection the following are suggested: (10) Ophthalmological Examination, especially for sclerotic changes in the retinal vessels. (11) X-ray of extremities with soft tissue technique for evidence of arteriosclerosis. (12) Steiglitz N itrate Test for Arteriosclerosis in hypertensive cases. A diastolic pressure of 100, and/or a systolic pressure of 200 or more should be regarded as being in the danger zone. We no longer hear of the occurrence of sudden deaths due to "acute diges tion" and other vague maladies. We have learned that almost invariably the cause of death in such cases is due to coronary occlusion. All physicians engaged in railway service should familiarize themselves with the essential predominant symptoms of coronary occlusion since the recognition of the condition when the patient is first seen may result in the preservation of a life. Laymen working in railway shops, and all trainmen, should be cautioned against moving any person who is suddenly seized with a shortness of breath and a feeling of oppression around the heart. These persons should bo kept in a recumbent posture, with the tics and collars open at the neck, until the physician arrives upon the scene. To undertake to transport these patients to their home or hospital may result in a fatality. A person having suffered from a coronary occlusion should be considered unfit for any future employment in engine service. Heat Cramps With the approach of summer months, your Committee feels that attention should again be directed to what has previously been stated with reference to heat cramps and the prevention thereof. Proceedings of I t is a well established fact "bends" and several other nar excessive perspiration, which ri its sodium chloride content. T1 sweating is replaced by the dri: sodium chloride is taken in a s\ tained, heat cramps may be avc I t has been estimated th a t a.25 grams of salt may be extra hours by excessive sweating. Salt tablets are available as ! with dextrose added for those r easier to get employees to swal would be to get them to take either would answer as well. Various machines for dispensi of drinking water are now upoi somewhat as a stimulus to ren with each drink of water. R Your Committee made a rep< appears in the Proceedings of tl and Surgical Section. The Air Hygiene Foundatioi attention to the study of pnei allied trouble. The Chairman o of the Ab Hygiene Foundation November, 1937, and Novembe A resum of the principal poi is as follows: Dr. Willard E. Hotchkiss, ! Carnegie Institute of Techno! The important feature brought were lost each year on account this running up to some six rnilli was stressed as being exceeding of illness. Emphasis was also m for more injuries than the act being less costly than correctiv Mr. Philip Drinker, Chairma "Engineering Progress t Report of Preventive Engii Expressed little that could b< of specially constructed paint sj American Railroads in twelve (12) Rules to be applied in the tut. swing features should be investigated and a with each other: 30pic. te in any of the above would disqualify n the case of the reexamination of emexamination is recommended, including: plus fluroscopy. v.P.N. and blood sugar. and Its Effect upon Heart, Pulse, Blood iay be needed to complete and confirm following are suggested: ion, especially for sclerotic changes in soft tissue technique for evidence of eriosclerosis in hypertensive cases. or a systolic pressure of 200 or more he danger zone. of sudden deaths due to "acute diges- have learned that almost invariably to coronary occlusion. All physicians uliarize themselves with the essential collision since the recognition of the l may result in the preservation of a and all trainmen, should be cautioned snly seized with a shortness of breath ;art. These persons should lie kept in 1 collars open at the neck, until the undertake to transport these patients atality. >nary occlusion should be considered le service. mps your Committee feels that attention eviously been stated with reference f. Proceedings o f Medical and Surgical Section 37 I t is a well established fact th a t the condition known as "heat cramps," `bends" and several other names, is in reality a condition brought on by xcessive perspiration, which removes from the blood a large percentage of its sodium chloride content. The amount of water carried off by this excessive sweating is replaced by the drinking of equal or large amounts of water. If sodium chloride is taken in a sufficient quantity to make up for the loss sus tained, heat cramps may be avoided. It has been estimated th a t as much as 15 pounds (2 gallons of water) and 25 grams of salt may be extracted from a normal man in the course of 24 hours by excessive sweating. Salt tablets are available as a m atter of convenience and may be obtained with dextrose added for those who prefer this combination. I t is frequently easier to get employees to swallow a tablet with each drink of water than it would be to get them to take granular salt or drink a salty water, though either would answer as well. Various machines for dispensing salt tablets at or in proximity to the supply of drinking water are now upon the market. These are quite handy and act somewhat as a stimulus to remind the worker that he must partake of salt with each drink of water. Pneumonoconiosis Your Committee made a report on the subject of Pneumonoconiosis, which ppears in the Proceedings of the Seventeenth Annual Meeting of the Medical nd Surgical Section. The Air Hygiene Foundation of America, Inc., has given much time and Mention to the study of pneumonoconiosis, silicosis, anthricosis and other hied trouble. The Chairman of your Committee attended the annual sessions f the Air Hygiene Foundation of America, Inc., held in Pittsburgh, Pa., in November, 1937, and November, 1938. A resum of the principal points stressed by the speakers at these meetings s as follows: Dr. Willard E. Hotchkiss, Maurice Falk Professor of Social Relations, darnegie Institute of Technology: "Social Aspects of Industrial Health." The important feature brought out by this speaker was th a t two million days vere lost each year on account of failure in health of employees--the cost of his running up to some six million dollars. The cost of training new employees vas stressed as being exceedingly heavy--much more so than the prevention >f illness. Emphasis was also made of the fact th a t acts of man are responsible 'or more injuries than the act of God; and much was said as to prevention )eing less costly than corrective measures. Mr. Philip Drinker, Chairman, Preventing Engineering Committee: "Engineering Progress toward further Protection of Industrial Health; Report of Preventive Engineering Committee, Including Plans for 1939." Expressed little th a t could be applied to Railroad work, but made mention of specially constructed paint spray booths and exhaust systems for plants. 38 Association of American Railroads Mr. T, P . Hatch, New York State Division of Industrial Hygiene: "State Codes for Control of Industrial H ealth." D ealt extensively with unintelligent regulations in the several State Codes, and made recom mendation of the adoption of certain fundamental principles which might be incorporated in all. He insisted th a t the various Codes should be grounded on facts and authentic data; and stated th a t the objections to the several State Codes are that they are not definitely and intelligently worded and should solve the problems of little industries as well as large. He stated th at the Codes, as at present existing, had a tendency to stifle progress and they should be rewritten so as to become educational, and to embrace common sense. He stressed the fact th at less then 10 per cent of accidents were due to mechanical failures. Mr. Theodore C. Waters, Chairman, M aryland Occupational Diseases Commission: " Legal Trends of Interest Respecting Industrial Health." This speaker stated that twenty-one States now have Compensation Laws but what is, or what is not, an Occupational Disease was not definitely defined by the Law. His idea is th at Occupational Diseases are conditions which are due to some peculiarity of the occupation. Dr. A. J. Lanza, Chairman, Medical Committee: "Medical Progress Toward Further Protection of Industrial Health; Report of Medical Committee, Including Plans for 1939." This speaker stated th a t in his opinion instead of removing man from dust infection work th a t the dust should be removed from the work. He urged periodic examinations, and stated that tuberculosis, or a tendency thereto, increases disability. He stated that there is no specific treatment known for silicosis. He urged th at a check be made on the absenteeism to learn whether the illness be really due to occupational illness or to a general illness. He also referred to an International Labor Board which has made some investigations along these lines. Dr. E. P. Pendegrass, University of Pennsylvania Hospital: "Some Practical Considerations Concerning Lung Changes Among Silica Workers." The only factor of interest brought out was th at pure silica produces definite nodular fibrosis. Dr. Leroy U. Gardner, Director, The Saranac Laboratory: "Report on Further Researches on `Mixed' Dusts and `Protector' Dusts." Had nothing in particular th at was not covered by other papers. Dr. S. Reid Warren, Jr., Associate Director, The Moore School X-ray Laboratory: "Comparison of Film and Paper in Roentgenographic Work." Dealt quite extensively with the use of X-rays made directly upon paper and those made on films--and this might be of interest to the railroads in making check-ups and in examination of applicants. The speaker stated th a t of 1342 films made, 114 made on paper and 39 made on film were not diagnostic. In other words, they were not Roentgenograms of any value. He called attention to the fact th a t X-rays on paper show reflected Proceedin light, whereas, those possibly more detaile adequate for industri trast, and not as mar' to the cheapness and work and general ob: be detailed with films Mr. V. P. Ahearn, E # eiation: "Industrial and Pu the Wagner Act car employers and empk He stated that the V unless the Supreme C Law. In previous reports you: frequent foci of infection i low back pain, and varioi. tained some slight acciden injury. The teeth, tonsils quently found sites of sue Studies are now being r Infection among Railroad t because of permanent and The Railroad Retireme tiun of this work by plac the records of physical t retired for disability. in these studies an ern of past existing and neg tributing cause of more constitute disabilities, an. the production of disablir. It is purposed to prepa: groups, geographical loea site and degree of the foe To date eighty (80) ca therefore, only a prelimin The approximate avers The most commonly fo tion is the teeth. History of, or the exis' focus of infection is not u 0/ American Railroads Proceedings of Medical and Surgical Section 39 fate Division of Industrial Hygiene: ^ Industrial Health." D ealt extensively withl he several State Codes, and made recom-'f certain fundamental principles which might % nsisted that the various Codes should bef itic data; and stated th a t the objections;^ h a t they are not definitely and intelligently Is rohleirs of little industries as well as large./! t present existing, had a tendency to stifle f w ritten so as to become educational, and stressed the fact th a t less then 10 per cent meal failures. rman, Maryland Occupational Diseases peering Industrial Health." This speaker now have Compensation Laws but what ual Disease was not definitely defined by >ationa! Diseases are conditions which are ;cupation. al Committee: urther Protection of Industrial Health; deluding Plans for 1939." This speaker 1 of removing man from dust infection removed from the work. He urged that tuberculosis, or a tendency thereto, i iai there is no specific treatm ent known ck be made on the absenteeism to learn to occupational illness or to a general m International Labor Board which has ese lines. Pennsylvania Hospital: s Concerning Lung Changes Among of interest brought out was th a t pure rosis. Saranac Laboratory: on `Mixed' Dusts and `Protector' th a t was not covered by other papers. Director, The Moore School X-ray in Roentgenographic Work." Dealt -rays made directly upon paper and ht be of interest to the railroads in in of applicants. The speaker stated on paper and 39 made on film were y were not Roentgenograms of any th a t X-rays on paper show reflected light, whereas, those made on film show transmitted light and therefore possibly more detailed b ut stressed the point th a t paper is sufficiently adequate for industrial surveys--though the sharpness was not as con trast, and not as marked as in the films. His suggestion was th a t owing to the cheapness and rapidity of paper, same is recommended for survey work and general observation, and cases requiring further study could be detailed with films. Mr. V. P . Ahearn, Executive Secretary, National Industrial Sand Asso ciation : "Industrial and Public Relations Aspect of Industrial Health," stated the Wagner A ct cannot accomplish the purpose intended until both employers and employees are disposed to compromise with each other. He stated that the Wage and Hour Law cannot be held constitutional unless the Supreme Court reverses itself in its ruling on the Child Labor Law. Foci of Infection In previous reports your Committee has brought to your attention the more frequent foci of infection responsible for arthritis of the spine and other parts, low back pain, and various other complaints which an employee, having sus tained some slight accidental injury, may be inclined to connect with the said injury. T he teeth, tonsils, prostate, colon, and hemorrhoids are the more fre quently found sites of such infection. Studies are now being made by your Committee of the incidence of Foci of Infection among railroad employees retired under the Railroad Retirem ent Act because of permanent and total disabilities. The Railroad Retirement Board is indulgently cooperating in the prepara tion of this work by placing a t th e disposal of a member of the Committee, the records of physical examination of railroad employees who have been retired for disability. In these studies an endeavor will be made to analyze the probable effect of past existing and neglected foci of infection as the immediate and con tributing cause of more serious defects which become sufficiently severe to constitute disabilities, and the effect of presently existing foci of infection to the production of disabling defects. I t is purposed to prepare these studies so th a t analyses may be made in age groups, geographical location, location and degree of disabling defects, and site and degree of the focus of infection. To date eighty (80) cases have been reviewed. The following data are, therefore, only a preliminary report on this phase of your Committee's work. The approximate average age of the group studied is fifty-nine years. The most commonly found previously and presently existing focus of infec tion is the teeth. History of, or the existence a t the tim e of examination of, more than one focus of infection is not uncommon. 40 Association of American Railroads The most common disabling defect is of the cardio-vascular system and the diagnostic types exist in the following order: 1. Myocardial degeneration. 2. Hypertensive heart disease. 3. Arterio-sclerotic heart syndrome, in which group is included the coronary insults and accidents. 4. Valvular heart disease. The preliminary examination of records appears to confirm the experience among railroad surgeons that: 1. Periodic physical examinations with the discovery and early removal of foci of infection (teeth, tonsils, naso-pharynx and accessory sinuses, prostate, colon and hemorrhoids) will conserve the collective health and physical preservation of the individual, prolong work capacity, increase work efficiency, and increase the age increment of disability groups. 2. Railroad employees are fairly generally neglectful of balanced diets, recreation, and proper physical exercise. 3. Improvement of well-being and contentment may be expected to follow some specific program of instruction for the larger groups of railroad employees in health preservation and disease prevention, particu larly in the numerical reduction of disabling cardio-vascular dis turbances. Your Committee expects to continue this special study and to present to you, in a later report, a tabulation of some 400 or 500 cases who have been retired under the Act. Rehabilitation In a previous report (May 25, 1938--Circular M & S 200) your Committee has indicated the structural difficulties presented by contracts between the railroads and employee organizations to the promotion of any constructive endeavor in rehabilitation of partially disabled employees. The transfer of partially disabled railroad employees 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 practice from the viewpoint of the employee as well as the employer. Rehabilitation policies and programs for the education and train ing of men disqualified because of increase in the accident risk created by his physical defect could he adopted and made effective if sympathetic interest and support could be developed. 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 employee has a human and morale value which should be promoted. This has to do with the preparation, through education, of those employees who are approaching the age in which disqualifying physical defects and Proceed enforced retirement becc the individual and the efficiency of personnel demands. I t is a common exp< unprepared for retireme and are not only separa lives, in a moat unhapp; unjust and unreasonabi neither economically or Considering the elenn lective efficiency in raih practically all railroad < expect retirement becai that age will be rare exc I t would, therefore, b fact that experience (a) ages of 55 and 65; (b) tli engaging and interesting curity and unhappiness to maintain interest aft< It is recommended tb program of instruction ; authorities in order tha1 mental interest in the a the event of retirement The Railroad Retire! under which annuities \ a. The employee r employment f construes to I V). Must, be sixty (( service. The interpretation w provision of this Act, p from service because o increase in the aceidem in the railroad organizi The age and service li ability annuities places I t is inconsistent wi fifty years of age to aci the return for the work >NVYT,v >fAmerican Railroads ict is of the cardio-vascular system and the! ing order: drome, in which group is included th e | ients. ecords appears to confirm th e experience = >ns with the discovery and early removal ,h, tonsils, naso-pharynx and accessory 1hemorrhoids) will conserve the collective rvation of the individual, prolong work ficiency, and increase th e age increment y generally neglectful of balanced diets, deal exercise. d contentment may be expected to follow' traction for the larger groups of railroad vation and disease prevention, particurction of disabling cardio-vascular dis- ue this special study and to present to some 400 or 500 eases who have been Proceedings of Medical and Surgical Section 41 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. I t is a common experience th a t railroad employees are psychologically unprepared for retirement because of disqualifying physical defects or of age and arc not only separated from the work to which they have devoted their lives, in a most unhappy mental state, b ut 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 employees who reach the age of sixty-five years may expert retirement because of physical defects and that continuance beyond th at age will be rare exception rather than the indulgent practice. It would, therefore, be appropriate to give all employees knowledge of the fact that experience (a) justifies the anticipation of retirement between the ages of bo and 05; (b) the transition from active railroad work to mentally less engaging and interesting existence on a retired status creates a sense of inse curity and unhappiness unless some compensating avocation is developed to maintain interest after retirement. I t is recommended th a t appropriate action be taken in the organization of program of instruction and education through the brotherhoods and railroad authorities in order th a t employees may be fully informed of the necessity of mental interest in th e attainm ent of physical health and contentment when the event of retirement is imposed upon them. Jitation -Circular M & S 200) your Committee s presented by contracts between the to the promotion of any constructive lisabled employees. ilroad employees from a specific type i and in which he is proficient, but some physical defect, would appear h ut of the employee as well as the Programs for the education and train ee in the accident risk created by his rade effective if sympathetic interest adoption and practice of a positive for a form of rehabilitation, which, rice accomplishments of the employee >uld be promoted. rough education, of those employees disqualifying physical defects and Retirement The Railroad Retirem ent Laws recite in general the following condition under which annuities will be paid to physically disabled railroad employees: a. The employee must be totally and permanently disabled for regular employment for hire in any work (railroad or other) which the Board construes to be substantial and not trifling, and b. M ust be sixty (60) years of age or have completed th irty (30) years of service. The interpretation which the Railroad Retirement Board has made on the provision of this Act, presumes th a t railroad employees who are discontinued from service because of physical disqualification and consequent intolerable increase in the accident risk, may be transferred to less exacting occupations in the railroad organization or, without difficulty, secure other gainful work. Tiie age and service limitation of the Act in determining eligibility for dis ability annuities places all men beyond fifty (50) years of age. I t is inconsistent with past and present experience to expect individuals fifty .years of age to acquire proficiency in new occupations which will make the return for the work substantial and n ot trifling.  A r-Ji'.'j 42 Association of American Railroads Proceeding Considerable confusion and, a t times, considerable difficulty have been expe rienced in presenting to the Railroad Retirement Board evidence of physical disability sufficiently convincing to warrant prompt action in favorably con cluding th a t the individual is entitled to disability annuity under the Board's interpretation of the Act. ignored if the happiness i promoted in the transition Disabled employees, who are under sixty-five years of age, are largely dependent upon the railroad surgeons for successful promotion of their cause. In conclusion, your Co The Retirement Board has very properly recognized the " carrier" Surgeons assistance rendered by the as the medical authority to make the physical examination of employee earnestly solicit a continual applicants for disability annuity. This is as it should be. The Board has with its further endeavors, provided a special form of history and physical examination, designated is endless, and we, therefoi I i-a Form ISfo. B-58. with the request th a t same T he Railroad Retirement Board is charged with the responsibility of deter mining from the report of physical events and findings included in Form B-58 the eligibility of the applicant for annuity under the provisions of th e Act. The responsibility of determining total and permanent disability cannot Com. be legally delegated, in fact or inference, to the designated examiners. T hat must be done by the Railroad Retirement Board. From the foregoing it is patent th a t "Reports of Physical Examination" must be complete and convincing as to existence of disqualifying defects and in degree to permanently and totally disable. The procedure established for the consideration and processing of applica tions for disability annuity appears sound and reasonable. The Chairman: Dr. Gs of several gentlemen who hs fore we go ahead with the other announcement or two The use of selected "carrier" Surgeons as the medical authority designated to procure and represent in reports of physical examination the nature and degree of disqualifying defects and disabilities is proper. No other class of , . . Secretary Cavist ing the day's and evening's medical examiners can understandingly and sympathetically represent the disabled railroad employee in securing his rightful retirement heritage when his working capacity is reduced to the necessity for complete relinquishment of earning ability. Under the Railroad Retirement Act the Board is the responsible authority T he Chairman: Follow these several gentlemen w Gamer's paper, we will hav< into the subject further. Fii designated to determine eligibility of employees for disability annuities. The Board cannot legally transfer or delegate its authority or responsibility to medical examiners or others to finally determine "total and permanent disability" under the Act. This determination must be made by the Board. The work of the Board and the interests of the totally disabled employee Disculsion pertaining to habilitation, presented at t Section of the Association and 16th, 1939, can be advanced by careful, complete, and positive preparation of the Report of Physical Examination, Form B-58. This report should, in each instance, contain a statement of the conclusive diagnoses which are disabling, supported D r. H arvey 1 by a full statem ent in the several paragraphs of the symptoms and physical signs which were developed in reaching the diagnosis. The requirements of the Railroad Retirement Board are reasonable and necessary. The fulfillment of these requirements lies in the preparation of Reports of Physical Examination which give a recitation of a clinical picture which indu bitably shows the applicant to be permanently and totally disabled under the interpretation of the basic law. This is an important obligation of Chief Surgeons--one which cannot be Colds: Persistent, baffling and r. greatly modify the prevalei forms, is a gentle reminder oi We can all too well descri another problem. Industry pays a tremendc phase of collective hum an ex We advise educational an without signal success. I t is edge th at has not yielded, thf Proceedings of Medical and Surgical Section es, considerable difficulty have been expe~5 1 Retirement Board evidence of physical 'k varrant prompt action in favorably con- ? i to disability annuity under the Board's ignored if the happiness and contentment of railroad employees is to be promoted in the transition from active service to retirement. ler sixty-five years of age, are largely 1 3 for successful promotion of their cause. :i operly recognized the "carrier" Surgeons the physical examination of employee : his is as it should be. The Board has and physical examination, designated charged with the responsibility of deterents and findings included in Form B-58 j lity under the provisions of the Act. total and permanent disability cannot i nee, to the designated examiners. T hat j aent Board. ;: lat "Reports of Physical Examination" j' o existence of disqualifying defects and ' Usable. onsideration and processing of applica- ; und and reasonable. ms as the medical authority designated j f physical examination the nature and , sabilities is proper. No other class of j ;ly and sympathetically represent the .1 ; his rightful retirement heritage when % ecessity for complete relinquishment of the Board is the responsible authority ' mployees for disability annuities, delegate its authority or responsibility .ally determine "total and permanent nation must be made by the Board, rests of the totally disabled employee tnd positive preparation of the Report j This report should, in each instance, ; ignoses which are disabling, supported /j graphs of th e symptoms and physical ; the diagnosis. The requirements of i isonable and necessary. ^ lies in the preparation of Reports of ,'x ation of a clinical picture which indu- ~ | nently and totally disabled under th e I? hief Surgeons--one which cannot be In conclusion, your Committee desires to express appreciation of the assistance rendered by the member lines and their Chief Surgeons and to earnestly solicit a continuation of this support and cooperation in connection with its further endeavors. I t is obvious th at the work of this Committee is endless, and we, therefore, respectfully submit the data herein contained with the request that same be accepted as a Progress Report. Respectfully submitted, C om m ittee on D isability and R eh a b ilita tio n , J. R. G a r d n e r , M.D.,..Chairman. T he Chairman: Dr. Garner's report will now be followed by the remarks of several gentlemen who have been asked to discuss special aspects of it. Be fore we go ahead with these discussions 1 believe Secretary Caviston has an other announcement or two to make. . . . Secretary Caviston made a few additional announcements regard ing the day's and evening's program.. . . T he Chairman: Following the presentation of the papers and remarks of these several gentlemen who are going to take up specific aspects of Dr. Garner's paper, we will have a general discussion in case anybody wishes to go into the subject further. First we will hear from Dr. Bartie. Discussion pertaining to the report of Committee on Disability and Re habilitation, presented at the Annual Meeting of the Medical and Surgical Section of the Association of American Railroads, Chicago, 111., June 15th and 16th, 1939, by D r. H arvey Bartle, Chief Medical Examiner, Pennsylvania Railroad. Colds: Persistent, baffling and misunderstood. The inability to check, retard or greatly modify the prevalence of common colds in its sporadic or epidemic forms, is a gentle reminder of our medical limitations. We can all too well describe it minutely but prevent or abort its progress is another problem. Industry pays a tremendous toll. I t disrupts home life, school life and every phase of collective human expression a t times. We advise educational and hygienic measures, with a definite plan and yet without signal success. I t is practically the only thing of which I have knowl edge th a t has n o t yielded, the cause of which I c a n n o t a n sw e r. 44 Association of American Railroads I personally feel like adding to 6-b especially orange juice and perhaps there would be objectors to it. I would be audacious enough to make another suggestion No. 7--When you have a cold go to bed, whether you have a fever or not and whether or not you call a physician, of course the latter is highly desirable. I would not advocate any lessening of our professional activities-- I t would isolate. I t would prevent secondary infections. It would hasten recovery. Surely most desirable accomplishments. Full recovery will stem the tide of disseminators. Not long since I sent out a questionnaire as to the efficacy, use and recognized results following the use of bacterial vaccines "Hypo." It was forwarded to a representative group of physicians in all classes throughout U. S. Their gracious replies indicated about 75% favorable in all aspects and practically 100% when we consider it as an agency to curtail the secondary manifestations. My personal opinion is a favorable one, covering an industrial use of about two million injections during the past twenty years. We failed to collect statistics to definitely prove this impression. We have not used the oral type, if effective of course it would be more desirable. As to medical aids, I feel Codeine Sulphate is par excellent. Cardiovascular-Renal Disease: With the recent refinements in disgnosis it is becoming more and more apparent the role the heart plays as an exit to man in leaving the joys, trials and tribulations incident to twentieth century life. Cardiacs whom we expect to pass on live, many persons pass out through the cardiac route whom we do not expect to do so, :-.s there are no previous symptoms or signs illicitable on which to predicate such an end. Of course, blood pressure should be studied; except in few cases it is not a predictable factor. There should be limits established when properly taken, beyond which it is unreasonable to continue persons in hazardous work. With laboratory measures, such as Bkg., X-ray, etc. together with clinical symptoms, we can segregate about two-thirds of cardiac deaths; there are, however, about one-third remaining in the category referred to above who pass out suddenly, on or off duty, and who have been regularly examined periodical ly with no record of any abnormality. We should heartily endorse the suggestion of more general use of ophthal moscope to give an accurate picture of eye grounds, x-ray of extremities to which reference has been made, as well as the dorsalis pedis pulse to formulate a composite picture. Precipitating factors--over-exertion, putting the heart muscle on the stretch, thus over-stretching the sclerosed coronary artery, emotional aspects, physical effort and over indulgence. We can admonish against over-weight, use of tobacco, emotional stress or strain, excessive physical effort. Do not be unwarrantedly perturbed when you have unexpected sudden heart deaths, we all have them. If you do not, remember the story of the ostrich. Proceedin The compiling of d ata su assistance in enlarging our s Medical history pertinet are important consideratio Symptoms--Gastro-intes gestive phenomena are hel The proper appraisal of t ments.and also a possible tests are becoming more n< the heart and kidneys and i With the accomplishme impedimenta the life span discussion to become an in We do not meet the artf be the safety agents as all ir Therefore, the recogniz< sought and eradicated ea removed. Surely the last word has j It emphasizes the exped transportation industry t o : Expressing our apprecia still recognize there are me T he Chairman: We w Pacific Railway. Dr. A. W. I de (Norther the report read by Doctor of this Section. In that r clinical aspects of this dise. value to the Association. 1 problem and deals largely ' committee is to be commei to our attention. The word "pneurnoconi< the lungs caused by inhalf include various diseases th; sis, Anthracosis, Asbestos! There is a great variety c various ways. Certain me lungs by inspiration and ca stances may be inhaled ai bronchitis. Other substan flammatory process in the The work th at has been < The conclusion has been r silicosis. I t has been show inactive when taken into t great variety of other sut merican Railroads specially orange juice and perhaps there I lake another suggestion No. 7--When i have a fever or not and whether or not is highly desirable. :| ){ our professional activities-- | ctions. its. sseminntors. ire as to the efficacy, use and recognized ecines `'Hypo." It was forwarded to a classes throughout U. S. iut 75/o favorable in all aspects and as an agency to curtail the secondary :ie, covering an industrial use of about twenty years. We failed to collect sion. effective of course it would be more rate is par excellent. nosis it is becoming more and more exit to man in leaving the joys, trials nturv life. Cardiacs whom we expect irough the cardiac route whom we do rious symptoms or signs illicitable on udied; except in few cases it is not a .its established when properly taken, ue persons in hazardous work, g., X-ray, etc. together with clinical -thirds of cardiac deaths; there are, s category referred to above who pass e been regularly examined periodical- tion of more general use of ophthal;ye grounds, x-ray of extremities to the dorsalis pedis pulse to formulate putting the heart muscle on the coronary artery, emotional aspects, use of tobacco, emotional stress or rhen you have unexpected sudden do not, remember the story of the Proceedings of Medical and Surgical Section 45 The compiling of data surrounding such cases may eventually lead to further assistance in enlarging our sphere of diagnosis. Medical history pertinent, existing luetic infection, habits, eating, smoking are important considerations. Symptoms--Gastro-intestinal disturbances, respiratory difficulty, con gestive phenomena are helpful leads. The proper appraisal of the heart load depends much on the kidney involve ments,and also a possible long standing hyperglycemia. Functional kidney tests are becoming more necessary to approach a definite status evaluation of the heart, and kidneys and may reveal involving features. With the accomplishments in medical progress removing many physical impedimenta the life span has been increased, thus causing the subject of our discussion to become an important factor in the Geriatric field of medicine. Wo do not meet the artful malingerer in this group. We must of necessity be the safety agents as all involving issues are purely medical. Therefore, the recognized insidious and subtle focal infections should be sought and eradicated early to avoid irreparable damage before they are removed. Surely the last word has not been said in the human heart role, i t emphasizes the expediency of periodical examinations in persons in the t mils)ortation industry to avoid jeopardizing life and property. Expressing our appreciation of this splendid report of th e Committee we still recognize there are more worlds to conquer just around the corner. T he Chairman: We will next hear from D r. Ide, Chief Surgeon, Northern Pacific Railway. D r. A. W. I de (Northern Pacific Railway): Doctor Gam er has referred to the report, read Doctor J. D. Collins on pneumoconiosis a t the last meeting of this Section. In th a t report, Doctor Collins described in some detail, the clinical aspects of this disease. His report was comprehensive and was of real value to the Association. Doctor G ainer's report wisely omits this phase of the problem and deals largely with quotations from various authors. The present committee is to be commended on again bringing this very important problem to our attention. The word "pneumoconiosis" comes from the Greek and means, "disease of the lungs caused by inhalation of dust." I t is a general term and is used to include various diseases th at are caused in this way. These diseases are: Silico sis, Anthracosis, Asbestosis, and kindred conditions. There is a great variety of dust th a t may be inhaled and m ay cause disease in various ways. Certain metals such as lead and arsenic may be taken into the lungs by inspiration and cause definite and rapid poisoning. Certain other sub stances may be inhaled and cause chronic irritation, and such conditions as bronchitis. O ther substances will cause immediate irritation and an acute in flammatory process in the lungs. The work th a t has been done on this subject has included various substances. The conclusion has been reached th a t the real problem in pneumoconiosis is silicosis. I t has been shown th a t other substances are comparatively inert and inactive when taken into the lungs. This is true of coal dust, iron dust, and a great variety of other substances. The actual trouble resulting from these 46 Association of American Railroads substances is due to the silica content and the resulting silicosis, so th a t prac tically speaking, the problem is silicosis rather than pneumoconiosis. I t is interesting to note that there are very considerable changes due to these other substances. I recently saw a post mortem on a patient who had worked in an iron mine all his life. The lung was the red color of iron ore and was very heavy. He must have had a very considerable amount of disability due to this siderosis. There is very voluminous literature on this subject. The articles have been more numerous of late. Possibly some of you may have noticed a recent lay article th at appeared in Collier's Magazine, June 3, 1939, entitled "Dust fights Dust." This article refers to work th at was done in Toronto, in the laboratory of Sir Frederick Banting, in connection with a mine in Canada. This article claims th at if silica dust is mixed with aluminum dust, it is rendered harmless. I have not yet seen the scientific article describing this work, but this lay writer seems to think th a t this pretty much solves the problem. The Federal Reporter, May 1, 1939, page 432, cites the case of Pieczonka, vs. Pullman Company. I t was alleged in this case that the plaintiff's life was shortened because of silicosis contracted while engaged in sand blasting. Silicosis is caused by the inhalation of silica dust. The particles of silica must be in a very finely divided state and the pathology resulting is in proportion to the extent to which the silica has been pulverized. This substance is taken into the lungs in this finely divided state and this material is acted upon by the body and produces the characteristic changes of silicosis. Silicosis has been a recognized disease for a great many years. I t was known as Grinder's or P otter's rot; it was also known as Miner's Pthysis, the latter indicating the early conception of the relation of pulmonary tuberculosis with silicosis. It is stated th a t pulmonary tuberculosis predisposes to silicosis, and conversely, th a t silicosis predisposes to pulmonary tuberculosis. In this country, this subject was studied in 1924, 1925, and 1926 among the granite cutters at Barre, Vermont. This was reported in the U. S. Public Health Bulletin No. 187, in 1929. It was found that the men working in this industry would usually develop this disease after working for about 10 years. The rapidity with which the patient develops silicosis is dependent on various factors other than time; particularly their own physical condition and the character of the dust inhaled. During the past 10 years, silicosis has main tained a prominent place as an industrial problem and a compensation disease. Silica is used in industry in vast quantities. I t is estimated that 100 million tons are sold in this country annually. This material is used in the building trades, as railroad ballast, cleaning and polishing industries, and in a vast number of other industries. I t is present everywhere and a great many people inhale dust containing this substance. The number of people who inhale the dust in sufficient quantities to do real damage is of course, relatively small. I t is no doubt true, that a small quantity of this dust does no harm. Otherwise, practically our entire population would be somewhat affected. However, there is a very considerable number of people who are exposed to this dust in suffi cient quantity to be dangerous. Silicosis as a railroad problem has apparently not been considered. Our Section has not given this m atter the consideration to which it is entitled; I do not believe it has ever expressed an opinion as to whether or not silicosis is really a railroad problem. In a general sense, it would seem th a t it is not a Proceedings i serious problem. The followii workers may develop silicosis: Miners, quarriers, drillers, s workers, manufacturers of scoi and other ores. It will be noticed th a t in till workers in Railway service tht that the Railroads do engage i nected with railroading, as ff would seem th at there is a vei operation. It would seem nee a detailed study of this subj< actual experience of our railroi how many claims for silicosis this matter has been very limi in other parts of the country 1 This disease is insidious, vt curable. Anything that this 1 would certainly be worthwhil T h e Chairman: Our ne> Surgeon, St. Louis-San Franc I I Chief Surgeon First I would like to quote Headers Digest of May, 19; A. IX: `Employment is na happiness.'' " From the doctors of the women workers to provide b< Training schools for occupatu iime on, the prophecy of Dr. 1 in the American Expeditionai He odd: `Some day occupati the suffering out of sickness. !t is only during the past twe place in rehabilitation of the growth of the World War." ' The Aetna Rehabilitation Aetua Insurance Company . crippled workmen and has p r humanitarian standpoint, bui point. The treatment is eh justment is also indicated. F> the patient becomes discoura.; react to the situation by de 0/ American Railroads Proceedings of Medical and Surgical Section 47 tent and the resulting silicosis, so th a t praeJL licosis rather than pneumoconiosis. if e are very considerable changes due to these.'J serious problem. The following incomplete list is given as occupations where workers may develop silicosis: Miners, quarriers, drillers, sand pulverizers, sand blasters, grinders, asbestos workers, manufacturers of scouring soaps and powders, miners of iron ore, lead, 1 a patient who had worked in an iron mine' ; 1 color of iron ore and was very heavy. He samount of disability due to this aiderosis. tire on this subject. The articles have been some of you m ay have noticed a recent lay lagazine, June 3,1939, entitled "D ust fights th at was done in Toronto, in the laboratory ction with a mine in Canada. This article ith aluminum dust, it is rendered harmless, iele describing this work, but this lay writer ch solves the problem. 939, page 432, cites the case of Pieezonka, !ged in this case that the plaintiff's life was acted while engaged in sand blasting, n of silica dust. The particles of silica must !the pathology resulting is in proportion to ;n pulverized. This substance is taken into I and this material is acted upon by the body 11ges of silicosis. ease for a great many years. I t was known also known as Miner's Pthysis, the latter ije relation of pulmonary tuberculosis with y tuberculosis predisposes to silicosis, and >to pulmonary tuberculosis, studied in 1924, 1925, and 1926 among the This was reported in the U. S. Public t was found that the men working in this disease after working for about 10 years. t develops silicosis is dependent on various ly their own physical condition and the 1 ing the past 10 years, silicosis has main- trial problem and a compensation disease. lantities. I t is estimated th a t 100 million y. This material is used in the building and polishing industries, and in a vast sent everywhere and t great many people ;. The number of people who inhale the damage is of course, relatively small. I t y of this dust does no harm. Otherwise, d be somewhat affected. However, there pie who are exposed to this dust in suffi- 1 apparently n o t been considered. Our ;onsiueration to which it is entitled; I do opinion as to whether or not silicosis is cabsense, i t would seem th a t it is not a and other ores. It will bo noticed th a t in this list, the sand blasters seem to be about the only workers in Railway service th a t would be likely to contract silicosis. I t is true that the Railroads do engage in many industries other than those strictly con nected with railroading, as for example, mining. If these are eliminated, it would seem that there is a very small field for the study of silicosis in railroad operation. It would seem never the less, advisable for the committee to make a detailed study of this subject. I t would be interesting to know what the nett ml experience of our railroads has been in the compensation for this disease: how many claims for silicosis have been considered. Our own experience in Ihis mat ter has been very limited. 1 am very sure th a t the railroads operating in other parts of the country have had more, experience than we have had. This disease is insidious, very definitely a compensation disease, and is in curable. Anything th a t this Section can do to throw any light on the subject would certainly be worthwhile. T he Chairman: Our next speaker will be Dr. R. A. Woolsey, Chief Surgeon, St. Louis-San Francisco Railway. REHABILITATION By D r . R. A. W o o l se y , Chief Surgeon St. Louis-San Francisco Railway First I would like to quote from an Article entitled "The Work Cure" in the Readers Digest of May, 1939--"The Greek philosopher Galen said in 172 A. D .: `Employment is nature's best physician and essential to human happiness." "From the doctors of the American Expeditionary Forces came a call for women workers to provide bedside occupation for sick and wounded soldiers. Training schools for occupational therapists were hastily set up, and from th a t time on, the prophecy of Dr. Thomas W. Salmon, chief consultant in psychiatry in the American Expeditionary Forces, has step by step, begun to be fulfilled. Ho said: `Some day occupational therapy will rank with anesthesia in taking the suffering out of sickness, and with antitoxin in shortening its duration, it is only during the past two decades that occupational therapy has taken its place in rehabilitation of the indigent. This' new profession is really an out growth of the World W a r/" The Aetna Rehabilitation Clinic a t Sj'racuse, N. Y. was developed by the Aetna Insurance Company especially to improve the physical condition of crippled workmen and has proven to be a worthy enterprise, not only from the humanitarian standpoint, b ut has been fully justified from an economic stand point. T he treatm ent is chiefly physiotherapy. On occasion mental read justm ent is also indicated. Following a serious injury with prolonged disability the patient becomes discouraged and his self-confidence is shattered. Patients react to the situation by developing a hobby, or some outside interest, and 48 Association of American Railroads Proceedings of ill with improvement of their physical condition will resume their normal support could be developed and i activities. There is still room for enormous expanse in this new field for all its the employe and employer. growth in two short decades, only 792 of the 6,189 hospitals in the United The railroad employe over 65, v States, approved by the American Medical Association, have occupational therapists on their staff. from the Retirement Board and vantage of this program. Yet, t Infection and its possibilities are one of the biggest hazards in industrial over a period of many years shou surgery. Severance of muscle tissue, tendons and nerves must be in the hands of competent surgeons who will make proper repairs. work to idleness, creates an ins< ponsating avocation is developed ; A mechanic whose fingers are stiff after injury and operation should be given It is recommended that approp something to do that requires finger motion, which should be kept up and in program of instruction and educ: creased until he is able to get back on his job. One whose shoulder is stiff authorities in order that employe following a fracture and immobilization might be put at wood work with a mental interest in the attainmen saw which would gradually make him reach farther and farther and eventually file event of retirement is impose bring the shoulder back to normal. m In fracture cases immobilization is essential and in order to get immobili T he Chairman: Gentlemen, -wrs zation the contiguous joints must be immobilized. In splint and cast applica discussions which followed it, by tions one must be careful th a t the dressing is not too tight as it will hinder open for general discussion. Doi circulation and cause edema. The dressing must not be left on too long be any additional comments? cause long inactivity of the joint alone produces stiffness and takes more time to work back to normal. In the treatm ent of muscles and joints, infra-red, diathermy, massage, and muscle re-education plays an im portant part. Reconstructive plastic oper ations corrects crippling deformities. Dr. John J. Moorhead of New York City makes the statem ent th a t it is more apparent than ever that prompt and efficient care of the injured is the best safeguard against disability and deformity. Long ago he made the state ment that the maximum of surgical treatm ent meant the minimum of disa bility. The American Association of Occupational Therapy, with headquarters in New York, acts as a clearing house for information. One need not speculate about the future of the new profession; its benefits for patients are being demonstrated daily. Occupational therapy must not be confused with vocational rehabilitation, though the two sometimes overlap. The latter aims to give the patient a school whereby he may earn his living: the former is primarily curative. Dr. Garner: Mr. Chairman particulars with my good friend subject of Pneumonoconiosis and cosis, and kindred conditions, qui have been made on th at subject i T he Chairman: Is there any Does anyone care to ask any qui D r. G. G. Dowdall (Illinois Lancaster is the one who has bee vention of colds, by oral adminisi about the general results which lie still considers it to be an exp< a'.".>'.-.-! ,, . rri-r, -' :- - - Many employes, because of injury or anatomical defects, are disabled in their particular line of work, such as train service, but are able to carry on in some other line of duty, such as watchman, crossing flagman, etc., but even though their seniority rights have to be forgotten, as they are in some other class of work, they are able to earn a livelihood and have something to occupy their minds, which means a great deal to the individual. I have seen many employes who have been in active service over a long period of time, p u t on pension at the age of 70, this before the Retirement Board existed, who were in as good a physical condition at th a t time as they were 20 years previously, and without occupation of any kind, slipped rapidly and died within a couple of years who, if they would have been allowed to carry on, would have been competent and their activity would have kept them from worry and mental strain and been responsbile for longer life and happiness. The education and training of men, disqualified in their own particular occupation, can fit them for another class of work if sympathetic interest and Dr. W. J. L an ca ster (Atlant Gentlemen: The results we ha factory. I will say this: that w commending an oral vaccine. I nevertheless show that among ou etc., the data is fairly comprehet beneficial in about 37% to 40% Our number of absentees from years, since we have been using We have found no bad effects fr< the same sort of reaction which jection has been given them: th upset for a day or two after they noticed no ill effects from it and the personnel. We are using it ' of Amanean Railroads Proceedings of Medical and. Surgical Section 49 ysical condition will resume their normalaenormous expanse in this new field for all its ily 792 of the 6,189 hospitals in the United an Medical Association, have occupational are one of the biggest hazards in industrial'JK me, tendons and nerves must be in the hands ike proper repairs. iff after injury and operation should be given ;er motion, which should be kept up and intek on his job. One whose shoulder is stiff ization might be put at wood work with a him reach farther and farther and eventually 1. support could be developed and would be of human and moral value to both the employe and employer. The railroad employe over 65, with over 30 years service can get full returns from the Retirement Board and the majority of the employes will take ad vantage of this program. Yet, these men -who have been actively employed o v er a period of many years should be advised th a t the transition from active work to idleness, creates an insecurity and unhappiness, unless some com pensating avocation is developed to maintain interest after the retirement. it is recommended that appropriate action be taken in the organization of a 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 attainm ent of physical health and contentment when the event of retirement is imposed upon them. n is essentia] and in order to get immobiiibe immobilized. In splint and cast appliea,e dressing is not too tight as it will hinder .e dressing m ust not be left on too long bedone produces stiffness and takes more time Tut: C hairman" Gentlemen, you have heard Dr. Garner's report and the diM-u.-sions which followed it, by three of our members. The report is now open for general discussion. Does any one wish to ask any questions or offer any additional comments? 1 joints, infra-red, diathermy, massage, and sortant part. Reconstructive plastic oper- "a es. * York City makes the statem ent th at it is S mpt and efficient care of the injured is the ad deformity. Long ago he made the state- ;al treatm ent m eant the minimum of disa- * ecupational Therapy, with headquarters in i e for information. One need not speculate 'ession; its benefits for patients are being be confused with vocational rehabilitation, p. The latter aims to give the patient a 1 mg: the former is primarily curative, iry or anatomical defects, are disabled in js train service, but are able to carry on in atchman, crossing flagman, etc., but even to be forgotten, as they are in some other a livelihood and have something to occupy deal to the individual. I have seen many service over a long period of time, put on i e the Retirement Board existed, wffio were hat. time as they were 20 years previously, ; 1, slipped rapidly and died within a couple ; s een allowed to carry on, would have been i 1 have kept them from wrorry and mental j r life and happiness. men, 'disqualified in their own particular J r class of work if sympathetic interest and A 1)r . G arner: Mr. Chairman, 1 feel th a t 1 must take issue in one or two particulars with my good friend, Dr. Ide. Our committee has handled the subject of Pneumonoconiosis and all its allied diseases, such as silicosis, anthracosis, and kindred conditions, quite extensively in the past, and several reports have been made on that subject in previous meetings, by this Committee. T he Chairman: I s there anybody else who wishes to make any comments? Does anyone care to ask any questions? Dr. G. G. D owdall (Illinois Central System): I understand th a t Dr. Lancaster is the one who has been engaged in this work with regard to the pre vention of colds, by oral administration. I 'd like to ask him to say a few words about the general results which he has obtained and to tell us whether or not lie still considers it to be an experimental process. Dr. \V. J. Lancaster (Atlantic Coast- Line Railroad): Mr. Chairman and Gentlemen: The results we have had have been on the whole, most satis factory. I will say this: th a t we have been criticized by some doctors for re commending an oral vaccine. While our records are not absolute ones, they nevertheless show th a t among our clerical forces, particularly in office buildings, etc.., the data is fairly comprehensive. Our records show th a t it has been very beneficial in about 37% to 40% of the cases. Our number of absentees from work on account of colds in the past couple of years, since we have been using an oral vaccine, has been materially reduced. We have found no bad effects from it. Some individuals have a mild reaction, the same sort of reaction which they would experience after a hypodermic in jection has been given them: that, is, they have a little ache, or they fee1a bit upset for a day or two after they first start to take it. B ut beyond th at we have noticed no ill effects from it and we think th a t it has been of material benefit to th e personnel. W e are using it right along. 50 Association o f American Railroads T he Chairman: Thank you, Dr, Lancaster. I believe Dr. McCombe has something to say to us on this subject. Dr. J ohn M cCombe (Canadian National Railways): Dr. Lancaster told us about this at one of the meetings of the Committee on Disability and Re habilitation, after which we got in touch with our people and made arrange ments for a limited supply. We used it in specially selected cases, so th a t per haps our figures are a little wrong, but we found it efficacious in about 35% to 40% of the cases in which we used it. T he Chairman: Does anyone else have anything to say a t this time? Dn. A. W. Boufflettr (Chicago, Milwaukee, St. Paul & Pacific Railroad): I move you th a t the Report of the Committee on Disability and Rehabilitation be accepted as a progress report. . . . The motion was seconded, put to avote and unanimously carried. . . . T he Chairman: We are very fortunate in having w ith us to-day the gentleman who is going to be our next speaker. He is going to discuss a subject in which we are all deeply interested. I now have the pleasure of introducing to you Mr. M. E. Lynch, Director, Claim Service, Railroad Retirement Board, Washington, D. C. Mr. Lynch! (Applause.) Mr. M. E. Lynch: Mr. Chairman and Gentlemen: I realize th a t this meeting is interested primarily in the application of the disability provisions of the Railroad Retirement Acts. I thought, however, th a t you would be in terested in a discussion of the basic provisions of the law relating to the pay ment of the various types of benefits authorized under the Railroad Retirement Acts. Under the Railroad Retirement Acts of 1935 and 1937, the Board makes five types of payments to employes or their dependents. These are: (1) Employe annuities, both disability and old age, paid to eligible individuals; (2) survivor annuities, paid under joint and survivor elections to the surviving spouse of a deceased employe annuitant; (3) death benefit annuities, paid only under the 1935 Act to the surviving spouse or dependent next of kin of a deceased an nuitant or employe entitled to.au annuity under th at Act; (4) lump-sum death benefits, payable only under the 1937 Act, with respect to the death of any employe who earned compensation under the Act after December 31, 1936, to a designated beneficiary or to the legal representative of the deceased employe; (5) pensions to individuals who were on the pension or gratuity rolls of em ployers under the 1937 Act, both on March 1 and July 1, 1937. Annuities based on age and service are awarded to eligible employe appli cants who have attained age sixty-five. Applicants who have completed thirty years of service may receive a reduced annuity upon the attainm ent of age sixty. Applicants for annuities based on disability must be shown to be totally and permanently disabled for regular employment for hire and, if they are less than sixty years of age, must have completed at least thirty years of compen sated employer service. Employes totally and permanently disabled who have had less than thirty years of employer service, may qualify upon the attainm ent of age sixty regardless of the number of years of service. Proceedings o f . A t the close of business on Mi annuities had been received by tl cations from 6,572 employes wh< to annuities as of th a t date. 11, The balance of the cases, or app and the applicants were found Board or were found to be ineligi considered. In the case of individuals whi monthly amount of age and disa compensated service not to exce and on compensation earned by was not in excess of $300 in any oi not employes on the enactment d service subsequent to December uuity rate for employes who ha service and are in service when th pensation used in the computal possible from original records. L to report monthly earnings of em Board, for many years to come, sation prior to that date from err In order for an employe to January 1, 1937, he must have b an employment relation thereto Act, an individual is in an emplo; call for service and ready and wili on account of sickness or disabilit and practices in effect on the em Where an employe was not in termination of the existence of a vestigation to ascertain if there is ship could exist. The determinat the facts in the individual case : employer which the Board has Approximateiy 23,000 claims cove require special consideration for feature, of which 2,500 are now ii An employe may elect to have t of a reduced annuity during his lif Section 4 of the 1937 Act require to be valid, must have been filed j date, it must be made a t least fiv' begins to accrue, unless the appli the Board. Such proof, in order t the employe is free from any disci his normal life. An election made prior to age sixty, based upon employment for hire and thirty ye life annuity may be awarded to s