Document VJ9GYaXJ8avOjobL9629Eo2Kw

FILE NAME: Railroads (RR) DATE: 1935 June DOC#: RR003 DOCUMENT DESCRIPTION: Proceedings of the 15th Annual Meeting of the Medical and Surgical Section - American Railway Association L, ) 9 7( f r Q .'b 'i < , 7 . , m n '>' y $ t *-= ' ''t.'. 4''"'-tN-.i"ii-' . ' -:'; "';i'`*fV'..;. I.;.'-|`;';. ,v"Yc 1' - . --.'i$ ^ HE S3l Z 7 I S 1 J K S I --------- a 8 IW Association of American Railroads PRO CEED IN GS OF THE FIFTEENTH ANNUAL MEETING 'OF THE M ED IC A L A N D SU R G IC A L SECTIO N CHALFONTE-HADDON HALL ATLANTIC CITY, N. 1 JUNE 10f 11,1935 MW PRO CEED IN GS OF THE FIFTEENTH ANNUAL MEETING OF THE Association of American Railroads M ED IC A L A N D SU R G IC A L SECTIO N HELD AT CHALFONTE-HADDON HALL, ATLANTIC CITY, N. J. JUNE 10,11,1935 E astern P rinting Cobforation N ew York, N . Y. 193d D:: -A AT - v- i, PG.j 9: INDEX Association of American ilailroa.de. B oard of D irectors..........................................- ........................................................................ O perations an d M aintenance D e p artm e n t................. ....................................................... O perating Division: officers............................................................... - ........................... . Officers........................................................................................- ......--...................................... B allot for officers, com m ittee of direction and com m ittee on nom inations--.................... B artle, H arvey: introducing D ean Lewi-- .................--.......................................................... Suggesting vote of thanks to retiring chairman..--.......................................................... Page 5 t) 6 5 45-46 69 114 Medical and Officers. Personm Regulati Reprt-stM M etz, A. R.: Milholland, 1 C am pos L,, F. J.: le tte r from....................................................................................................... C ardiac hazard and the railroad: paper by Frederick A. Williu. ................................... C om m ittee (special) on medical aspects of air conditioning of cars.............................. R eport of...................................................................................................................................... Discussion........................... ........ ................................. ...................................................._ C om m ittee on developm ents resulting from periodic physical exam inations...^............ . R eport of........................................................................................................................... Discussion o n ..................................................................................................................... C om m ittee of direction.................................................................................................................... R eport of............................................ ........................................................................................ Discussion on........................ ............................................................................................. C om m ittee on disability and rehabilitation...... ........................................................................ R eport o f....................... -.....................................--. ....................--......... -............ ...... ......- .. 113 10-28 8 07 98-112 8 62-68 69 6 49-50 50-51 7 86-94 Morse. R. C. Neupauer, A Nilsson, Join lutroduc. Xntroduc Remaps Remark Physical stiii Plum m er, 8. Iritrodue Dieeussi Rossiter, Rea in r Discussion on.............................................. .................................... .................................. C om m ittee on fraotures.-................................................ ......................................... .................... R eport of...........................-.............................................. ............................................-............ Discussion on._................................................................................................................... C om m ittee on nom inations................ ............................................................................................. R eport of................................... -.................................................. -............-.......-............-.......... C row der, T. It.: presenting report of com m ittee on medical aspects of air conditioning of cars........................................................ ......... .............................. .............................. -- Downes, J. R .: le tte r from ............ ................................................................................................. 94-97 7 29-37 39-43 7 44-47 96-112 15 Sim ilarity of Adi Warring, F, ( W ebb, KobC\ Discussi Weil, G. C .: Williu, Fred WooUey, It. Taylor, >S. li. Election of officers, mem bers of com m ittee of direction and com m ittee on nom inations.. 44 R esult of................................................. ............................................ -.......... -- ............. ....... 113 F ractu res: p ap er by D ean Lewis............................................................................................... 69-80 F ro st, J. G .: discussion on report of com m ittee on fractures.............................................. 40-41 Presenting rep o rt of oommittee on nom inations.............................................................. 44 Discussion on report of com m ittee on medical aspects of air conditioning of cars...... 110 1 Fulton, W. S.: inform al ta lk ............... ................................................................................. ........ G arner, J. R .: discussion on report of com m ittee on fractures............................................ 51 41-42 R em arks as incoming chairm an.............................................................................. .........-- 113-114 G honnley, J. W ,: presenting tellers report of election............................................................ 113 Herold, A rthur A.: rem arks concerning reciprocal transportation for railroad surgeons.. 115 H um e. A rth u r M .: telegram from................................................................................................. 52 L ancaster, W . J.: le tte r from ......................................................... ................................................ 112 Leigh, S outhgate: presenting resolution................................ 84 Lewis, D ean: p ap er on fractures................................................................................................... 69-80 M ayo, C harles: inform al rem arks............. 84-85 M ayo, W. J .: inform al rem arks........................................................ .............. .............................. 80-84 M cCombe, John: rem arks in connection with vote of thanks to retiring chairm an.......... 114-115 Page 5 6 5 45-40 69 m 113 19-28 8 97 98-112 ns. 8 2-6S 69 49- 50 50- 51 7 86-94 94-97 7 29-37 39-43 7 44-47 ir comii'iouicg 15 n nomina v.ous.. 44 113 69-80 40-41 44 ouing of cars.-- 110 51 41-42 113-114 113 liiroad surgeons.. 115 52 112 84 09-80 84-85 80-84 g chairman. 114-115 Index-- Continued Medical and Surgical Section. Officers.......................-....... -.................. -................................. ;.................................... -............. Page 6 Personnel of com m ittees............................................. -........................................................... 6-8 Regulations................................................................................................ -................................ 9-11 R epresentatives attending annual meeting.--................................ .................................. 12-14 M etz, A, R .: presenting report of com m ittee on disability and rehabilitation............... 94-95 M ilholland, E. V.: introducing R ear Admiral P. S. R ossiter............................................... 52 Discussion on report of com m ittee on medical aspects of air conditioning of cars...... Ill M orse, R. C.: letter from............ -.............................................. .................................................... 43-44 N eupauer, Adolph: discussion on paper on cardiac hazard and the railroad.................. 27 Nilsson, John I t.: opening rem arks as chairm an...................... ........................ ....................... 15-18 Introducing W. J. M ayo..... -..............................-........................... ......... -......................... 80 Introducing Charles M ayo..................................................................................................... 84 Rem arks on report of com m ittee on fractures.................................................................. 42 Rem arks on report of com m ittee on medical aspects of air conditioning of cars.... 110-111 Physical stan d ard s: suggested changes....................................................................................... 49-50 Plum m er, S. C .: discussion on report of com m ittee on fractures........................................ 39-40 Introducing J. l'h P ulver..................................................................... -.................................. ol Discussion on report of committee on medical aspects of air conditioning of cars 110 Rossiter, R ear Admiral, P. 8.: paper <m sim ilarity of surgery problems in the navy and in railway surgery................................... ......................................................................... 53-61 Similarity of surgical problems in the navy and in railw ay surgery: paper by Rear Admiral P. S. Rossiter.................. -......................................................................... -...... 53-61 W arring, F. C.t discussion on report of com m ittee on disability and rehabilitation.......... 96 Webb, Roseoe C .: presenting report of com m ittee on fractures...-.......................... -.28, 42-43, 48 Discussion on report of com m ittee on disability and rehabilitation....- .................... 97 Weil, G. C .: discussion on report of com m ittee on fractu res............................................... 41 Willius, Frederick A.: paper on cardiac hazard and the railroad.-- ................................. 19-28 Woolsey, H. A,: discussion on report of com m ittee on fractures........................................ 51 Taylor, S. B.: discussion on report of com nuttee on fractures............................................ 42 ASSOCIATION OF AMERICAN RAILROADS Officers J. J. Pelley, President It. V. Fletcher, Vice-President and General Counsel (Law Department) J. R. Downes, Vice-President (Operations and Maintenance Department) A. F. Cleveland. Vice-President (Traffic Department) E. H. Bunnell, Vice-President (Finance, Accounting, Taxation and Valua tion Department) H. J. Forster, Secretary-Treasurer Board of Directors J. J. Pelley, Chairman (ex-officio). L. W. Baldwin, Trustee, Missouri Pacific Lines. J. J. Bernet, President, Chesapeake & Ohio Railway, New York, Chicago & St. Louis Railroad and Pere Marquette Railway. Ralph Budd, President, Chicago, Burlington & Quincy Railroad. M. W. Clement, President, Pennsylvania Railroad. L. A. Downs, President, Illinois Central System. Geo. B. Elliott, President, Atlantic Coast Line Railroad. E. S. French, President, Boston & Maine Railroad and Maine Central Railroad. Carl R. Gray, President, LTiion Pacific System. Fairfax Harrison, President, Southern Railway System. Hale Holden, Chairman, Southern Pacific Company. Fred W. Sargent, President, Chicago & North Western Railway. H. A. Scandrett, President, Chicago, Milwaukee, St. Paul & Pacific Railroad. Daniel Willard, President, Baltimore & Ohio Railroad. F. E. Williamson, President, New. York Central System. rI' i* f S: i' lb :A 0 Association of American Railroads OPERATIONS AND MAINTENANCE DEPARTMENT J. Ji. Downes, Vice-President- DIVISION I--OPERATING Officers C. E. Denney, Chairman J. Cannon, Vice-Chairman J. C. Caviston, Secretary MEDICAL AND SURGICAL SECTION 1cm Officers Dr j. It. Garner, Chairman Dr. D. Ji. Moss, First Vice-Chairman Dr. Duncan Eve, Jr., Second Vice-Chairman J. C. Caviston, Secretary MEMBERS OF COMMITTEES Committee of Direction (Term expires June, 1936) Dr. J. R. Garner (Chairman), Chief Surgeon Western Railway of Alabama, Atlanta, Ga. Dr. D. B. Moss (First Viee-Chiiirman), Chief Medical Officer, Chicago, Burlington & Quincy Railroad, Chicago, 111. Dr. Duncan Eve, Jr. (Second Vice-Chairman ), Chief Surgeon, Nashville, Chattanooga & St. Louis Railway, Nashville, Term. Dr, Harvey liart-le, Chief Medical Examiner, Pennsylvania System, Phila delphia, Pa. Dr. John McCombe, Chief Medical Officer, Canadian National Railway, Montreal, Canada. Dr. E. V. Milholland, Medical & Surgical Director, Baltimore & Ohio Rail road, Baltimore, Md. Dr. John It. Nilsson, Chief Surgeon, Union Pacific Railroad, Omaha, Nebr. (Term expires June, 1937) Dr. A. It. Metz, Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Railroad, Chicago, 111. Dr. S. B. Taylor, Chief Surgeon, New York Central Railroad, Columbus, Ohio. D i.F . C. Warring, Chief Resident Surgeon, Western Maryland Railway, Baltimore, Md. Dr. A. J. Chrie Health Ami Dr. H. S. Cumin Health Sere Dr. 0 . . Zebus". Louie, Mo. Dr, L. A. Jdnsiuii Louis liailo : Dr. A. h i . ii Dr. S. C. Pluuinii Chie.'.yo. H i . Dr. it. A. Wool- [.nuis, Mo. C Dr. J. I). Collins I Va. Di'. .I. G. Frost, ( Dr. It. .1. Graves, Dr. W. J. Lanas; Wilmington, Dr. J. E. Fhrer, Dr. John MeCom Canada. Dr. !L C. Webb ( Minn. Dr. Bradley L. t N. Y. ' Dr. G. G. Davis, Dr. G. G. Dowd; Dr. O. B. Zeinert Dr. John R. Nils TMENT * *n :liv;iy of Alabama, Officer, Chicago, ugeon, Nashville, i:i System, Fililaiatiunal Railway, lore & Ohio Rail. Omaha, Nebr. . Paul & Pacific 'road, Columbus, u-yland Railway, Proceedings of Meih'cil and Surgical Section 7 Honorary Members Dr. A. ,1. Chesley, Secretary-Treasurer, Conference of State & Provincial Health Authorities of North America, St. Paul, Minn. Dr. H. S. Cumming, Surgeon General, Treasury Department, Bureau of Public Health Service, Washington, D. C. Committee on Nominations Dr. 0. B. Zcinert (Chairman), Chief Surgeon, Missouri Pacific Railroad, St. Louis, Mo. Dr. L. A. Ensminger, Chief Surgeon, Cleveland, Cincinnati, Chicago & St. Louis Railway, Indianapolis, Iud. Dr. A. M. Hurne, Chief Surgeon, Ann Arbor Railroad, Owosso, Mich. Dr. S. C. Plummer, Chief Surgeon, Chicago, Rock Island & Pacific Railway, Chicago, 111. Dr. R. A. Woolsey, Chief Surgeon, St. Louis-San Francisco Railway, St. * Louis, Mo. Committee on Disability and Rehabilitation Dr. J. D. Collins (Chairman), Chief Surgeon, Seaboard Air Line Ry., Norfolk, Va. Dr. .J. G. Frost, Chief Surgeon, Chicago & Eastern Illinois Ry., Chicago, 111. Dr, R. J. Graves, Chief Surgeon, Boston & Maine R. IL, Concord, N. II. Dr. W. J. Lancaster, Supt. & Med. Dir. Rel. Dept., Atlantic Coast Line II. R. Wilmingron, N. 0. Dr. J. E. Pulver, Chief Surgeon, Chicago & North Western Ry., Chicago, ill. Representative from Committee of Direction Dr. John MeCombe, Chief Medical Oiftcer, Canadian National Ry*., Montreal, Canada. Committee on Fractures Dr. R, C. Webb (Chairman), Chief Surgeon, Great Northern Ry., Minneapolis, Minn. Dr. Bradley L. Coley, Chief Surgeon, New York Central R. R., New York, N. Y .' Dr. G. G. Davis, Chief Surgeon, Elgin, Joliet & Eastern Ry., Chicago, 111. Dr. G. G. Dowdall, Chief Surgeon, Illinois Central System, Chicago, 111. Dr. 0. B. Zeinert, Chief Surgeon, Missouri Pacific R. R., St. Louis, Mo. Representative from Committee of Direction Dr. John R. Nilsson, Chief Surgeon, Union Pacific R. R., Omaha, Nebr. ft; ! :T 53- i l :.; dim. s Association of A'inerican Railroads Committee on Developments Resulting from Physical Examination Dr. S. C. Plummer (Chairman), Chief Surgeon, Chic., Rock Isld. & Pac. Ry., Chicago, 111. Dr. H. A. Beatty, Chief Surgeon, Canadian Pacific Ry., Toronto, Canada. Dr. W. N. Blount, Chief Surgeon, Gulf, Mobile & Northern R. R., Laurel, Miss. Dr. W. L. Hartman, Medical Director, New York Central Lines, Detroit, Mich. Dr. A. M. Hume, Chief Surgeon. Ann Arbor R. R., Owosso, Mich. Representative from Committee of Direction Dr.D.B.M oss, Chief Medical Officer, Chic., Burl. & Quincy R.R., Chicago, 111. Special Committee on Medical Aspects of Air Conditioning of Cars Dr. T. R. Crowder (Chairman), Dir., Dept, of San. & Surg., The Pullman Co., Chicago, 111. Dr. G. G. Dowdall, Chief Surgeon, Illinois Centra) System, Chicago, 111. Dr. R. A. Woolsey, Chief Surgeon, St. Louis-San Francisco Ry., St. Louis, Mo. : Representative from Committee of Direction 1. Rep revs geons or of In designated h 2. Affiliai; 3. The ofli and a Secono Dr. E. V. Milholland, Med. & Surg. Dir., Baltimore & Ohio R. R., Baltimore, 4. There si Md. sentatives o f. Chairman, tie S ! the past Clini The Commit! General of tit five to be tie:- Conference of 5. The Con authorize, ord of such commi Section. 6. Regular annually, the i ings of the Cor 7. The Chai mittee of Dina upon the First the First Yice- the Chairman Chairman pro i 8. There shal tives of mernbe 9. As candid Direction shall ; cal Examination ok Isld. & Pac. Ry., Toronto, Canada, hern R. R., Laurel, Lines, Detroit, Mich, so, Mich. tion y R.R., Chicago, 111. itioning of Cars g., The Pullman Co., m, Chicago, 111. Ry., St. Louis, Mo. ;tion hio R. R-, Baltimore, Proceedings of Medical and Surgical Section <! DIVISION I--OPERATING MEDICAL AND SURGICAL SECTION REGULATIONS Representatives 1. Representatives of members or associate members shall be Chief Sur geons or other officials engaged in a similar capacity. They shall be officially designated by the members or associate members they represent. 2. Affiliated members may be appointed by the Committee of Direction. Officers 3. The officers of the Section shall be a Chairman, a First Vice-Chairman and a Second Vice-Chairman. Committee of Direction 4. There shall be a Committee of Direction which shall consist of 10 repre sentatives of members or associat e members within the Section, including the Chairman, the First Vice-Chairman and Second Vice-Chairman of the Section, the past Chairman last holding office and 6 other representatives of members. The Committee shall, in addition, include in its membership the SurgeonGeneral of the United States Bureau of Public Health Service or a representa tive to be designated by him, and a representative to be designated by the Conference of State and Provincial Health Authorities of North America. 5. The Committee of Direction shall conduct the business of the Section, authorize, order, define duties, determine the number of and appoint members of such committees that may be necessary to properly conduct the work of the Section. 6. Regular meetings of the Committee of Direction shall be held semi annually, the date and place to be deckled by the Chairman. Special meet ings of the Committee may be held at the call of the Chairman. 7. The Chairman of the Section shall act as the Chairman of the Com mittee of Direction. In the absence of the Chairman his duties shall devolve upon the First Vice-Chairman. In the absence of both the Chairman and the First Vice-Chairman, the Second Vice-Chairman shall preside. Should the Chairman and both Vice-Chairmen be absent the members shall elect a Chairman pro tem. Committee on Nominations 8. There shall be a Committee on Nominations to consist of five representa tives of members or associate members not officers of the Section. 9. As candidates for the Committee on Nominations, the Committee of Direction shall select the names of ten representatives, five of whom shall be 10 Association of American Railroads elected. The candidate receiving the greatest number of votes for member IS. Si ship on the Committee on Nominations shall act as Chairman of that Com of Direr mittee. author!?,. 10. The Committee on Nominations shall, prior to the annual meeting, annual n select the names of two or more representatives of members or associate mem bers as candidates for Chairman, two or more as candidates for First Vice- Chairman and two or more as candidates for Second Vice-Chairman, and fi 19. T! representatives of members or associate members as candidates for the Com vested in mittee of Direction. 20. An 11. Any representative of a member or associate members may, at the man of t. annual meeting, nominate for officers or members of the Committee of Direc 21. Ti. tion such representatives as desired, provided th at such nominations have or SPC1aa been endorsed in writing by ten representatives of members or associate members. voting m : 12. The representatives of members or associate members nominated for officers or for the Committee- of Direction receiving the highest number of votes, shall be considered elected. Election l ; 13. The Chairman and Vice-Chairmen shall be elected annually by a ma if jority ballot and shall hold office for one year or until the close of the session at which their successors arc elected. The term of office of members of the Committee of Direction shall be two years and 3 members of the Committee -5/ shall be elected annually. To provide for the inauguration of the foregoing, 3 members of the Committee of Direction shall be elected at the annual meet ing in 1924 to serve for one year and 3 members to serve for two years. At subsequent annual sessions 3 members shall be elected to serve for (.wo years. ; 14. The election of officers and members of the Committee of Direction and Committee on Nominations shall be by printed ballot and only officially designated representatives shall be entitled to vote. When a ballot for election of officers or members of committees results in a tie such ballot must be retaken. 15. A vote in sessions of the Section may be taken viva voce, by rising, by roll-call or by ballot, if there is any doubt as to the result of a viva voce vote the Chairman can order, or on the request of three members, a roll-call vote ft. shall be taken in accordance with the practice of the Association of American Railroads, based on the number of memberships held by each member. ii'. Meetings of Committees I 16. Meetings of any committee may be held at the call of the Chairman of such committee unless for some special reason notification to the contrary : has been issued by the Chairman of the Section. tv Annual meeting of the Section shall be held in May or June, the time and place to be designated by the Committee of Direction. Special meetings may fe; be held at the call of the Committee of Direction. 17. If a member of a committee is absent from two consecutive regularly called meetings of the committee, his membership ceases ipso facto, and the Committee of Direction shall act as in a vacancy from any other cause. 1 ites for memberan of that Corn- annual meeting, r associate m an 's for First ViceChairman, and 6 ites for the Com iera may, at the Qinittee of Direcominations have ssociate members, rs nominated for ighest number of mnually by a malose of the session >f members of the of the Committee i of the foregoing, t the annual meetfor two years. At ve for two years, littee of Direction and only officially V'hen a ballot for ie such ballot must voce, by rising, by of a viva voce vote ers, a roll-call vote nation of American aeh member. of the Chairman of in to the contrary June, the time and pedal meetings may ansecutive regularly ipso facto, and the y other cause. Proceedings of M ediali and Surgical Section 11 18. Should a vacancy occur in the officers of the Section, the Committee of Direction or Committee on Nominations, the Committee of Direction is authorized to appoint a representative to fill such vacancy until the next annua] meeting. General 19. The right to hold office, vote and attend executive sessions shall be vested in representatives of members or associate members only. 20. An executive session of the Section may be held at the call of the Chair man of the Section or at the request of five representatives of members. 21. These Regulations may be amended by a majority vote at any regular or special meeting of the Section, subject to approval by two-thirds of the voting members by a letter ballot. r u ....: 12 Association of American Railroads MEDICAL AND SURGICAL SECTION New Y(. New Yo Chalfonte-Huddon Hall, Atlantic City, N. J., June 10-11, 1935 Long 1 The following representatives were present: Members Representatives Pcmisyh :v:- Alton It. R ......... ............... .............. E. V. Milholland, Medical and Surgical Director'. r.- Atlanta & West Point It. R ...... ........... J. It. Garner, Chief Surgeon. Baltimore & Eastern If. It........... .........Harvey Hurtle, Chief Medical Exami ner. Baltimore & Ohio Chicago Terminal R. It. .... ......... ........ .............................E. V. Milholland, Medical and Surgical Director. Baltimore & Ohio R. R. ........................E. V. Milholland, Medical and Surgical Pennsyiv Director1. Pekin A Belt Ry. Co. of Chicago ..................... B. C. Cushway, Radiologist. Pullman Canadian National Railways ..............John McCombe, Chief Medical Officer. Central Vermont R y...........................,,..L. E. Sample, Chief Surgeon. Reading Chesapeake & Ohio Rv..... .............. . W. T. Oppcnluruer, Chief Surgeon. W J. J. Braridalwr, Assi. Supervising ;f Surgeon. Chicago & Eastern Illinois R y.......... ... J. G. Frost, Chief Surgeon. B. C. Cushway, Radiologist. Chicago & North Western R y........... J. E. Pulver, Chief Surgeon. Chicago & Western Indiana R. R____J. G. Frost, Chief Surgeon. Chicago, Burlington & Quincy R. R. D. B. Moss, Chief Medical Officer. Richmon Chicago, Milwaukee, St. Paul & R. R. .. Pacific R. R ............ ... ........................ A. R. Metz, Chief Surgeon. Rutland i Chicago, Rock Island & Pacific R y... S. C. Plummer, Chief Surgeon. St. Louvs- Chicago, Rock Island & Gulf R y..... S. C. Plummer, Chief Surgeon. Seaboard Delaware & Hudson R. R. C o rp .........J. W. Ghnrmley, Company Surgeon. Union Pai Delaware, Lackawanna & Western St. Joeepi R. R .......................................................J. \'. White, Chief Surgeon. Virginian Denver & Rio Grande Western R. R...M. D. Currigan, Acting Chief Surgeon. Wabash 1 Erie R. R ..................................... ............W. E. Mishler, Asst, to Chief Surgeon. Georgia R. R._._................. .....................J. R. Garner, Chief Surgeon. Western J Grand Trunk Western R. R ________ G. W. Stockwell, Asst., Western Lines. Great Northern R y.................................R. C. Webb, Chief Surgeon. Western R Louisiana & Arkansas R y________ A. A. Herold, Chief Surgeon. Missouri Pacific R. R ______ O. B. Zeinert, Chief Surgeon. Montour R. R ............. ................. ..........G. C. Weii, Chief Surgeon. Association ds TION June 10--11, 1935 preservatives ad, Medical and Surgical Chief Surgeon. >, Chief Medical Exami- nd, Medical and Surgical nd, Medical and Surgical y, Radiologist, oc, Chief Medical Officer. Chief Surgeon, iimer, Chief Surgeon, abur, Asst. Supervising niff Surgeon, i;,-, Radiologist. Chief Surgeon, i'hief Surgeon. Chief Medical Officer. Chief Surgeon, or, Chief Surgeon, er, Chief Surgeon, ley, Company Surgeon. Chief Surgeon. ;an, Acting Chief Surgeon. :r, Asst, to Chief Surgeon. , Chief Surgeon, veil, Asst., Western Lines. Chief Surgeon. 1, Chief Surgeon, t, Chief Surgeon. Chief Surgeon. Proceedings of Medical and Surgical Section 13 New York Central System_____ __ ...F, V. Whiting, General Claims At torney. W. L. Hartman, Medical Director. New York Central R. R ...... ........... ...,S, B. Taylor, Chief Surgeon. N. Pennsylvania R. R._................................Harvey Bartle, Chief Medical Exami ner. Long Island R. R....... ...... ..................Walter Aye, Medical Examiner. J. W. Harper, Medical Examiner. A. P. Isenberg, Medical Examiner. Pennsylvania R. R. (cont'd) ..............T. B. I,. Jordon, Medical Examiner and Company Surgeon. II. E. Heston, Medical Examiner. It. C. Kell, Neurologist. J. S. Moses, Medical Examiner and Company Surgeon. J. E. Nickel, Medical Examiner. S. W. Thust, Medical Examiner. J. A. White, Medical Examiner. Pennsylvania-Reading Seashore Lines A. P. Isenberg, Medical Examiner. Pekin & Union Railway......................... J. E. Meloy, Chief Surgeon. Pullman Co............................... ...........T. R. Crowder, Director, Department Sanitation and Surgery. Reading Co..... ....................... ......... F. S. Ferris, Chief Medical Examiner and Chief Medical Officer. C. Detweiler, Medical Examiner. C. M. Glassmire, Medical Examiner. H. E. Klase, Medical Examiner. M. J. Murphy, Medical Examiner. Adolph Neupauer, Medical Examiner. .1. H. Orff, .Medical Examiner. Richmond, Fredericksburg & Potomac R. R............ .......... ............................. W. T. Oppenhirner, Chief Surgeon. Rutland R. R .......... .......................... S.W. Hammond, Chief Surgeon St. Louis-San Francisco Ry_______ R.A. Woolsev, Chief Surgeon. Seaboard Air Line R y.................... ,.J.D. Collins. Chief Surgeon. Union Pacific R. R...................... J.R. Nilsson, Chief Surgeon. St. Joseph & Grand Island R. R . .......M. L. Crandall, Surgeon. Virginian Ry........................................... Southgate Leigh, Chief Surgeon. Wabash Ry....... ............. ...... ................. D. A. Pence, Surgeon-in-Charge. W. E. Codings, Superintendent. Western Maryland Ry...- _____ __ ___ F. C. Warring, Chief Resident Sur geon. Western Ry. of Alabama....... ...... ...... J. R. Gamer, Chief Surgeon. also Association of American Railroads.......J. C. Caviston, Secretary. (M. & S. Section). L. Higinbotham, Company Surgeon. 14 Association of American Railroads Conference of State and Provincial Health Authorities of North America ..A. J. Chesley, Secretary. International Journal of Medicine and Surgery........ .......... .. .........................F. C. Lewis, Editor and Publisher. Mayo C linic......................... ... .........C. B. Mayo, M. D. W. J. Mayo, M. IX F. A. Willius, Cardiologist. The Johns Hopkins University, School of Medicine.................. .................. ... Dean Lewis, Professor of Surgery. United States N avy................................Rear Admiral P. S. Rossiter, Surgeon General. Wheeling Clinic............. ............... ........ W. S. Fulton, M. D. and G uests........ ....................................... ......E. II. Shields, M. D. F. I.. VanSickle, IVI. IX X r i,'.; IK 80 Association of American Railroads ASSOCIATION (C ircular M- S. 170) OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION Dr. G. W. Gale, Jr. (C hairm an), Chief Sur geon, St. Louis Southwestern Railway, Texarkana, Ark. (Deceased--Marc): 24, 1935.) D i. A. R. Kilgore. Chief Surgeon, W estern Pacific Railroad, San Francisco, Cali fornia. Dr. A. R. M etz (Acting Chairm an), Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Railroad, Chicago, Illinois. Dr. F. C. Warring, Chief Resident Surgeon, Western M aryland Railway, Baltimore, M aryland. Dr. J. G. Frost, Chief Surgeon, Chicago & Eastern Illinois Railway, Chicago, Illi nois. R epresentative from Com m ittee of Direction D r. J. R. Garner, Chief Surgeon, W estern Railway of Alabam a, A tlanta, Georgia N e w Y o r k , N. Y., May 1, 1935. To t h e M ed ic a l a n d S u rg ic a l S e c t io n : Since the organization of tiiis Committee, which has functioned under several names, practically all of the important subjects coming within its purview7have been discussed--some of them almost annually'. A number of them are and always will be ol' paramount interest and we feel should be kept constantly before this body7. As we become more careful and painstaking in our physical examinations, both witli and without the use of scientific instruments, such important diseases as syphilis of the central nervous system, diabetes, nephritis, focal infections, hypertension, coronary diseases of the heart, aortitis and aneurysm of the aorta and others mentioned in the list given below seem to occur with increasing frequency and all are of the gravest concern when occurring in train service employees and more particularly with those in engine service. In a measure this report is somewhat in the nature of a recapitulation as well as one to lay7emphasis on the important matters th a t have been discussed in past years. Procecdin The question of disabiii prime importance to the J vision as may be incomp can readily be recognized 1 been described from time These examinations, in tie visual acuity of the eruphous classes of service in t! present ophthalmologic pi Essentially we are eon,c e p t io n . Acuity, althoui grade in any satisfactory i in an extract from The Tr, ican Medical Association, port. This table, giving used in ordinary test card perception in percent. T1 twenty feet allows us to us, there is marked discrepanc for near and distant visa reader is referred to the re gates, American Medical Injuries (printed together formula is given for centra (Percentage near vi: TABLE FOR DETER PERCEPTION Snelien N otations at 14 inches A .M .A . "D iopter" or M eter Jaettor 14/14 14/21 14/24 14/28 14/35 14'42 14/49 14/56 14/70 14/84 14/98 14/112 14/140 14/16.8 14/224 0.37 D. 0.50 D. 0.02 D. ! 0.75 D. i 0.87 D. 1.00 D. 1.25 D. j 1.50 D. i 1.75 1), ; 2.00 D. I 2.50 D. 3.00 I), i 3.50D . ! 4.00 D. i 6.00 D. 8.00D. No 1 No' " No. 1 No. 6 No. No, 1 No. 10 N o. 11 No. 32 No. M N o. 16 No. 37 No. in NT. 10 No. 20 Proceedings of Medical and Surgical Section 87 Vision The question of disability and rehabilitation as concerns vision is of evident prime importance to the railway surgeon. The recognition of such defects of vision as may be incompatible with the working efficiency of the employee can readily be recognized by certain simple eye examinations that have already been described from time to time by the Committee on Physical Examination. These examinations, in the majority of cases, give us sufficient evidence of the visual acuity of the employee to enable us to determine his capacity for vari ous classes of service in the operation of a railroad. A certain few cases will present ophthalmologic problems that are best referred to the specialist. Essentially we are concerned with two requisites: a c u it y and c o l o r p e r c e p t io n . Acuity, although in itself a quantitative thing, is rather difficult to grade m any satisfactory numerical form. An attem pt to do this is set forth in an extract from The Transactions of the Section on Ophthalmology, Amer ican Medical Association, 1927. The table below is reproduced from this re port. This table, giving the corresponding size of letters and visual angles used in ordinary test cards, enables the examiner to express loss of macular perception in percent. The column giving corresponding Snellen notations at twenty feet allows us to use the same determination for distant vision. Where there is marked discrepancy between the percentage central visual perception for near and distant vision, certain ratio calculations are necessary. The reader is referred to the reprint from The Proceedings of the House of Dele gates, American Medical Association, 1925, Report of Committee on Eye Injuries (printed together with the extract described above) in which the formula is given for central visual efficiency of the eye in question as: (Percentage near vision X 2)-(-(Percentage distant vision X 1) 3 TABLE FOR DETERMINING PERCENTAGE LOSS OF MACULAR PERCEPTION FOR THE DISTANT AND NEAR TESTS Snellen N otations at 14 inches A .M .A . " D io p te r'' or M eter Jaeger Size in M m. of Letters at 14 inches Visual An^le for ali N o tatio n s Corre sponding Snellen N o tatio n s at 20 Feet Percent age Central Visual Perception Percent age I.oss in Visual Efficiency 14/14 14/21 14/24 14/28 14/35 14/42 14/40 14/56 14/70 14/84 14/98 14/112 14/140 14/168 14/224 14/336 0.37 D. 0.50 D. 0.6 2 D. 0.75 D. 0.87 D. 1.00 D. 1.25 D. 1,50 D. 1.75 D. 2.00 D. 2.50 D. 3 .0 0 D. 3.50 D. 4 .0 0 L>. 6.00 D. 8 .0 0 D. No 1 No. 2 No. 3 No. 4 No. 6 No. 8 No. 9 No. 10 No. 11 No. 12 No. 14 No. 16 No. 17 No. 18 No. 19 No. 20 0.502 0.735 0.853 1.004 1.255 1.506 1.757 2.008 2.510 3.012 3.514 4.018 5.020 6.024 8,032 12.048 0 7.5 8.5 10 12.5 15 17.5 20 25 80 35 40 50 60 80 120 20/20 20/30 20/33 20/40 20/50 20/60 20/70 20/80 20/100 20/120 20/140 20/160 20/200 20/240 20 320 20/430 100.0 91.4 89.5 83.6 76.5 70.0 63.9 . 58.5 48.9 40.9 34.2 28.6 20.0 13.0 7.2 2.0 0 8.6 10.5 16.4 23.5 30.0 36.1 41.5 51.1 59.1 65.8 71.4 80.0 .87.0 92.8 98.0 88 Association of American Railroads Having a menus of expressing percentage efficiency for macular perception, it is necessary to define limits of disability. For entrance into service in all classes, the applicant should present 100% C.V.P. (Central Visual Perception) in each eye, tested separately, without glasses. After acceptance in service, acuteness of vision should be tested at regular intervals. As regards employees in service, to determine defects of visual acuity and to establish rehabilitation in cases where such defects exist requires classification of various occupations and definition of the percentage limits for each. These limits are best ascer tained by the Individual Chief Medical Officer. Only genera! limitations are recommended in this presentation. Employees in engine and train crews, eligible for promotion, should present 91.4% C.V.P,, or better, in each eye, with or without glasses. For re-examination, the same group of employees only need evidence a C.V.P. of 83.0%, or better, in each eye, with or without glasses. If at any time such employee's C.V.P. tests 70.5% or lower in either eye, with or without glasses, he should be excluded from active train service and be rehabilitated in some occupation in which- visual requirement is less exacting. Employees in other branches of service should show at least 58.5% C. V.P., or better, each eye tested separately, with or without glasses. Below this figure the employee should be excluded entirely from any service con cerned with the active operation of trains and be assigned to an occupation where visual acuity is not an important factor. This assumes, of course, that the employee is wearing, at the. time of examination, glasses that correct any refractive error he may have. If there is any doubt that his present lenses are satisfactory, he should be re-examined after having new glasses prescribed by an ophthalmologist. C o l o r p e r c e p t io n can be examined by any of the devices marketed by reliable supply houses. Of these the Ishihara test for color blindness, based on the principle of figures traced in dots on contrasting colors, permits a quick, easy and satisfactory test of color vision. Even illiterates can trace the figures, and malingering is next to impossible in this method, Color blind ness is of two types--Complete and Partial (Red, Green and Blue). Either type constitutes a disability that necessitates removal of the employee from active train service, or any other occupation where color perception must be unimpaired. It should be borne in mind that color blindness can be acquired as well as congenita! and for this reason it is just as important in re-examina tions to test the color sense as to test the visual acuity. There are two other defects for which \vc must constantly be on the alert, which may be overlooked in examining only for acuity and color perception. These arc (1) limitation of extraocular movements, and (2) reduction of the size of the field of vision. Gross tests, using the fingers, give hint to any im pairment and this can be confirmed by an experienced ophthalmologist. His recommendation should be considered in those instances where there is a question as to the fitness of an employee for his occupation. Eye Changes in Diabetes Visual disturbances are rarely found in diabetes insipidus and in most in stances are associated with the cerebral complications of this disease, although Proceed several cases of entershave been reported. In diabetes meilitus , optic neuritis and opt: Accommodative and re bulbar optic neuritis is much alcohol and tobnso is usually a sign of Bernardo Eornaxxin: Diseases and brought n prevalent in employee, present are being tiroui surgeon for systematic Pneumoconiosis (pm i caused by any kind of b undoubtedly more inter. Silicosis is caused caused by breathing fix cium silicate. Asbesto.pulmonary fibrosis anAnthrocosis, which is d as serious in causing cm fine dust particles wifi minute and microscopic Silicosis, the most co: tion of the railroad su slowly. However, this changes in the lung a: severe types are found : are, however, cases call after exposure of from ! in individuals that arc free alkali as is found in I t should be underdo amounts of silica produ to tuberculosis. There with silicosis but are tuberculosis. According to Mortal' tissue averages 1.13 mg dioxide per gm. of did atmosphere. Assuming silicosis is present or no  Proceedings of Medical and Surgical Section 89 ? i- perception, several cases of cataract, retinitis, paralysis of the external rectus muscle service in ail have been reported. 1 Perception) e in service, ds employees ehabilitation In diabetes mellitus inflammation of the cornea, iritis, cataract, retinitis, t: optic neuritis and optic atrophy, especially retinitis, are not uncommon. Accommodative and refractive changes are of frequent occurrence. Retro bulbar optic neuritis is often noted in those having diabetes who also use occupations much alcohol and tobacco. In diabetic coma, the eyeball may be soft and if e best aseer- so is usually a sign of a bad prognosis. nitations are train crews, in each eye, Pneumoconiosis if employees h or without Bernardo Romazrini in 1717 published a classical book on Occupational iv'or in ei ther Diseases and brought out in detail, th at pulmonary disorders were especially train service prevalent in employees engaged in dusty occupations. These conditions at client is less present are being brought more and move to the attention of the industrial least 58.5% surgeon for systematic studies. sses. Below Pneumoconiosis (pneumon--lung; konis--dust) is a condition th a t may be .service con- caused by any kind of dust entering the lung; b ut we as railroad surgeons are i occupation undoubtedly more interested in silicosis and asbestosis than in the other types. course, that correct any esent lenses f Silicosis is caused by breathing free silica into the lungs; asbestosis is caused by breathing fine fibres of asbestos which consists of magnesium cal cium silicate. Asbestosis is not a common condition but it causes extensive s prescribed pulmonary fibrosis and takes on a more rapid course than does silicosis. Anthrocosis, which is due to coal dust, and siderosis, due to iron dust, are not narketed by as serious in causing complications as the other two just mentioned. These '.ness, based nits a quick, n trace the fine dust particles which produce these irritative lung conditions are very I minute and microscopic in size. t Silicosis, the most common dust disease and which is brought to the atten dolor blind- tion of the railroad surgeon the most frequently, in general develops very ie). Either slowly. However, this disease takes from ten to twelve years before the plovee from changes in the lung are sufficient to produce clinical findings. The most ;on must be severe types are found in cases after exposure of from 32 to 42 years. There be a cii uired arc, however, cases called "Acute Silicosis" that have been known to develop re-exarnina- after exposure of from four months to two years. The acute eases are found in individuals that are exposed to air containing silica which is mixed with >n the alert, free alkali as is found in powder plants where scouring powder is manufactured. -i perception, It should be understood that silica is found in the normal lung, but excessive etion of the amounts of silica produce connective tissue anti this predisposes the individual : to any ira- to tuberculosis. There are many cases of tuberculosis th at are not associated logist. His 1 there is a f: with silicosis but are diagnosed ns silicosis. This is the miliary type of tuberculosis. According to McNally, the silicon dioxide content of the normal dried lung tissue averages 1.13 mg. per gm. Any lung containing over 2 mgs. of silicon dioxide per gm. of dried lung tissue indicates undue exposure to a dusty in most inre, although atmosphere. Assuming that these findings are true, the decision of whether silicosis is present or not must be made by the pathologist and not left to the 90 Association of American Railroads chemist since the anatomical changes of silicosis are characteristic of the disease and only the anatomical changes determine disability and death. The clinical picture of the patient, with shortness of breath, must always be considered seriously. The X-ray findings, although very difficult to diagnose accurately, are of great benefit. The history of the patient is probably of the most importance in making an early diagnosis. In dealing with employees on entrance to service our suggestions would be: "Pain in the ba recent trauma or v has become a ela-: the exact cause is encountered that (1) For the physician to take a complete history and make a careful diagnosis, when pi physical examination. tests, X-rays and ; (2) To take an X-ray film of the chest for lung tissue for' diagnosis and at a loss to accoun future record. Probably the n I: In old employees with a history of working in dust and having the classical clinical symptoms we suggest; (1) To make a change in his occupation. conditions or anal of the proliferativi not be found uni small embedded b (2) To take an X-ray of his chest for lung tissue. pillar is very char In the way of prevention it becomes necessary (1) To educate all concerned. (2) Get rid of dust. cause of severe m 1 that their import!, cause of this corn! arthritis. (3) Sprinkle the working area with water. Influenza is alsi (4) Have employees wear inhalers. (5) Have frequent analyses made of the dust content of the air at different times during the working hours. its bad after effee different types of articular cartilage: means but are pri gitis and tubercuh. Amoebic Dysentery cases of pain in the examinations and The subject of Amoebic Dysentery has been previously covered quite thor oughly by this Section. We still recommend the maintenance of meticulous care in the preparations of all foods and strict adherence of the previous in structions to dining car employees. We further recommend in the treatment the use of Chipparo Amargosa (bitter root), a preparation th at can be taken both by mouth and by enema. Tiffs preparation is non-toxic and can be given in large doses without any toxic effects. Further, this preparation is very efficacious in any type of dysentery. The fluid extract can be obtained from Eli Lilly and Company or Sharpe & Dohme. In some instances the infusion made by boiling the actual Chipparo Amargosa (bitter roots) have given by far the best Jesuits. If results are not satisfactorily' obtained by the administration of the fluid extract we advise the use of the infusion. The actual Chipparo Amargosa (bitter roots) can be obtained usually through any large drug concern. By using either the fluid extract or infusion we overcome the extreme hazard of probably producing a permanent neuritis th at so often follows the administration of arsenical preparations. When this does happen many times the neuritis proves to be worse than the amoebic dysentery. Spondylolisthesi was formerly susj. thrown out of its the bodies of the v Curvature of thi culosis also causes In spondylolisth lumbar vertebra, i spine is limited, e: gram with the iliui must be taken to by the heavy crest preted and the ltd in spondylolisthesi: Lumbo-sacrul ne ditions one might cervical rib, sixth 1 the thorax and pe! mulbar vertebrae SSRXU:-- -------- ------ ------- - l f: Proceedings of Medical and Surgical Section 91 Pain in the Back "Pain in the back" in its various anatomical locations not associated with recent traum a or vertebral fracture or dislocation is one of the "worries" that has become a classic to the industrial surgeon. Under so many conditions, the exact cause is so difficult to determine and discouragement is so often encountered that untiring effort must be put forth to arrive at a correct diagnosis, when possible. Although all our diagnostic means, as laboratory tests, X-rays and physical findings, be carried out we must still admit we are at a loss to account for this pain in a vast number of cases. Probably the most difficult and most frequent of the many pathological conditions or anatomical anomalies causing this pain is arthritis, especially of the proliferative type. The foci of infection are so hard to find and many not be found until great permanent damage has already been done. The small embedded tonsil with the scarlet red line on the margin of the anterior pillar is very characteristic of a diseased tonsil which, in many cases, is the cause of severe arthritis. The tonsil is usually so small in these types of cases that their importance is easily overlooked and unappreciated as the direct cause of this condition. I t is advisable to remove the tonsils in all forms of arthritis. Influenza is also another type of infection that on many occasions leaves its bad after effects in the back, especially in the sacro-iliac region. These different types of infection many times produce osteophytes in the vertebral articular cartilages th at cannot be determined by means of X-ray of other means but are present, causing aggravating symptoms. Low grade menin gitis and tuberculosis are also types of infection producing back pain. In all cases of pain in the back, the teeth, tonsils, sinuses, chest and gastrointestinal examinations and studies must be carefully made. Spondylolisthesis (or sub-luxation) is a much more common condition than was formerly suspected. The weight bearing direction of the body being thrown out of its proper alignment, stretching the ligament attachment of the bodies of the vertebrae, causing severe back pain. Curvature of the spine due either to postural or by absorption os in tuber culosis also causes pain in the back. In spondylolisthesis there occurs the depression over the area of the fifth lumbar vertebra, the shortened torso and broadened pelvis. Flexion of the spine is limited, especially in the forward excursion. A lateral Roentgeno gram with the ilium slightly angled is essential to make the diagnosis. Care must be taken to throw the ilium out of the direct line or the shadow made by the heavy crest may be so great th at the X-ray film may be wrongly inter preted and the Roentgenologist thereby confused in making a correct diagnosis in spondylolisthesis. Lumbo-sacral neuritis, lumbar muscular spasm, are also quite common con ditions one might encounter. Anomalies are quite prone to cause pain, as cervical rib, sixth lumbar vertebrae, thereby increasing the distance between the thorax and pelvis, making a natural weakness. Spinous processes of the mulbar vertebrae being too short for proper muscular attachment of the liti 1 92 Association of American Railroads lumbar muscles. Many other conditions may be found, as spinal cord tumors, metastatic tumors, tumors of the kidney, stone in the kidney or ureter, enlarged prostate, advanced varicocele and especially pendulous ab domen, calcification of the ilio lumbar ligament and sacralization of the fifth lumbar vertebra. Trichinosis is a more common condition than is suspected and a blood microscopical examination for eosinophilia is helpful to make a diagnosis. We wish to repeat and advise that in conditions causing back pain, it is essential to remove the causative factor. It is necessary to have complete laboratory and X-ray studies, in the X-ray studies special attention to the lateral views. In regard to treatm ent the following procedures may be necessary: rest in bed with slight hyperextension of the spine, with a double Buck's extension and traction on the legs; application of body casts and body splints; removal of all foci of infection; injection of some foreign protein; manipulation under anesthesia for sacral region pain; immobilization either by fusion of the lower lumbar and sacral articulations; patient should receive salicylates and iodides by mouth; his diet should be carefully watched and his general physical con dition thoroughly cared for. The condition of "pain in back" is so serious and of such an economic value that too much stress cannot be put upon the importance of its proper manage ment and treatment. Cardio-Vascular-Renal Disease An employee in train service who after 40 years of age should at the periodic examination be examined minutely for evidences of early, as well as advanced, cardio-vascular-renal disease. Blood pressure readings where the systolic is over 170 and the diastolic over 100 should be repeatedly checked. Often after a rest, such as lying down for 15 to 30 minutes, the pressure may be found to be 20 to 30 millimeters lower. If the systolic exceeds 200, the employee should be removed from active service. Urinalysis should be made a routine part of the examination in all cases of hypertension and if albumin appears constantly in amounts in excess of a 1-millimeter ring in a freshly voided morning specimen, regardless of the sys tolic pressure, the individual should be given the advantage of complete rest. In borderline cases, examination of the eye-grounds may prove of great value. In those where a history of dyspnea, oedema, precordial pain and tachy cardia, especially after exertion, is given, even though clinical findings are in significant, an electrocardiogram is invaluable. On the other hand, cardiac irregularity or enlargement, or evidences of valvular disease may be found in individuals who deny any symptomatology. The danger of allowing such to continue in active train service must not be minimized. Again the electrocardiogram is of value determining the true character of an irregularity of the pulse or the apex beat. Proceedings of M e Fluoroscopic examination of the heart, but in some individuals wh diffuse widening of the aorta or ( The pre-vertebra! space with puli' th at "an aortic knob" may not be course, constitutes a definite hazr public and cannot be allowed to re Coronary disease without defini; positive electrocardiographic evide Suspects should be subject to mo cardiogram should bo resorted to fj In summarization, the rule that vascular-renal disease should be < preferably every three months slim At these examination, the follm ceuure where indicated: (1) Condition of heart and bh (2) El ectrocardiogram. (3) Repeated blood pressure n (4) Urinalysis. (5) X-ray of chest. (0) Examination of eye-groum Nothing new can be added on t the importance of careful obsen physical examinations and rout ins already in service. Would also recommend the adop for all applicants for employment a should be rejected. Obesity is one of our most imps railroad employees. This is evids examinations made of 7,500 ernplo; show that 16% of the men exami. list of physical defects, the first he Employees who carry an excess physical and mental activities wlm dependability and predisposes to s It is a medical observation tha viduals who are overweight. ; Proceedings of Medical and Surgical Section 93 Fluoroscopic examination of the chest often reveals not only an enlarged heart, but in some individuals where cardiac enlargement was suspected a diffuse widening of the aorta or even definite indications of an aneurysm. The pre-vertebral space with patient in lateral position should be used so ! that "an aortic knob" may not be thought to be aneurysm. The latter, of course, constitutes a definite hazard to self, fellow-employees and general public and cannot be allowed to remain in active service. Coronary disease without definite history of anginal attack or absence of positive electrocardiographic evidence may be suspected but not diagnosed. Suspects should be subject to more frequent examination and the electro cardiogram should be resorted to freely. In summarization, the rule th at individuals presenting evidence of cardio vascular-renal disease should be examined at least every six months and preferably every three months should be followed. At these examination, the following should form a rigid part of the pro cedure where indicated: \ (1) Condition of heart and blood vessels. (2) Electrocardiogram. (3) Repeated blood pressure readings. (4) Urinalysis. (5) X-ray of chest. (6) Examination of eye-grounds. Syphilis Nothing new can be added on this subject other than to again emphasize the importance of careful observation for evidence of syphilis in routine V physical examinations and routine use of Wassermann tests on employees already in service. Would also recommend the adoption of universal rule of blood examination for all applicants for employment and those with positive blood Wassermanns should be rejected. Obesity Obesity is one of our most important and frequent physical defects among railroad employees. This is evident by figures obtained in careful physical examinations made of 7,500 employees in operating service where the findings show that 16% of the men examined were overweight. This is second in a list of physical defects, the first being defective vision. Employees who carry an excess of weight tend to become sluggish in their physical and mental activities which in turn lessen their physical and mental dependability and predisposes to slow cerebration. It is a. modical observation that diabetes occurs more frequently in indi viduals who are overweight. 94 Association o f American Railroads The carrying of excess fat puts extra work on the heart and kidneys, which tends to exhaust prematurely the life of these two vital organs. Overweight is of a special concern in engineers, who after living an active life as a fireman become accustomed ot eating large amounts of food which is necessary for their work. When these men are promoted to engineers and carry on the duties of an easier occupation, they continue overeating, which results in a gradual increase in weight. In more recent years, it has been necessary for a number of these men who are overweight as engineers to re turn to firing due to reduction of forces, with result that they are easily ex hausted and unable to carry on the harder work due to weakened heart muscle and other general disturbances. I t is important that the employees' attention be repeatedly called to the dangers of overweight and that they be given some specific directions of how to correct the condition. With this in view, the Committee is submitting the accompanying folder, which contains the essentia! information th at the men can follow, (Note: Folder follows page 115). Respectfully submitted, C om m ittee on D isa b il it y and R e h a b il it a t io n , A. R. M e t z , Acting Chairman. D r. A. R. M e t z (Chicago, Milwaukee, St. Paul & Pacific Railroad): "Since the organization of this Committee, which has functioned under several names, practically all of the important subjects coining within its purview have been discussed--some of them almost annually. A number of them are and always will be of paramount interest and we feel should be kept constantly before this body. "As we become more careful and painstaking in our physical examinations, both with and without the use of scientific instruments, such important diseases as syphilis of the central nervous system, diabetes, nephritis, focal infections, hypertension, coronary' diseases of the heart, aortitis and aneurysm of the aorta and others mentioned in the list given below seem to occur with increasing frequency and all are of the gravest concern when occurring in train service employees and more particularly with those in engine service. "In a measure this report is somewhat in the nature of a recapitulation as well as one to lay emphasis on the important matters th at have been dis cussed in past years." I read this introduction in memory' of the Chairman of the Committee, Dr. Cale, as he had written the introduction and had sent out questionnaires to the Chief Surgeons for suggestions. Before having time to complete the work, he had written his introduction and gone to a hospital where he was operated upon and died. I t was while he was in the hospital th at he sent me this much of the report and the remainder of the Committee carried on and compiled the rest of the report. This is Dr. Gale's final contribution to this Association. Proceedhuj Acuity of vision has bee ticularly interested in this but will merely state that i Surgeons or the Medical ( centage of loss of the iimii There were some req upl and I requested Dr. Virgil road to give a short report rated in the report. Pneumoconiosis, as we importance. Dr. Frost, v, alert on the literature up marized in an article the e which if observed will be : comptish to avoid pueuruo.- Last year amoebic dyst! Dr. Frost told us about- Ci we felt that for the sake o; write a fewr paragraphs on ; Pain in the back has bet th a t has been appointed In nobody is going to solve i produces pain in the track : There was also a quest in committees have reported have asked Dr. S. It. SI; renal disease in Rush Med on all our cardic-vascular summary of his observatio result of his observation ai repeatedly and, of course, ii Syphilis is also a probh working on this problem wJ local conditions. Obesity is a more freqti amounting to about 16 per In order to treat this eo ; have devised a special diet table and is headed "Time When an employee is hr instructions to follow carer With the means of this outline of instructions that duce the desired results, if o This time table for red. Association for whatever u can be altered or changed Proceedings of Medical and Surgical Section 95 Acuity of vision has been very wo!l gone into by Dr. Warring who is par ticularly interested in this subject, and will not attem pt to read all of this, I- but will merely state that it is gotten up with the object of helping the Chief Surgeons or the Medical Officers to have a means of determining the per centage of loss of the acuity of vision. There were some requests for something on the eye changes in diabetes, and I requested Dr. Virgil Wescott, who is oculist for the Milwaukee Rail road to give a short report on the eye changes in diabetes, which is incorpo rated in the report. Pneumoconiosis, as we discussed it in the last meeting, is of increasing importance. Dr. Frost, who has been very much interested and has been alert on the literature up to the present time on pneumoconiosis, has sum marized in an article the essential facts th at we have, with recommendations which if observed will be all the protection that we can possibly hope to ac complish to avoid pneumoconiosis troubles. Last year amoebic dysentery received a certain amount of discussion, and Dr. Frost told us about Chipparo Amargosa and some made notes on it, but ; we felt that for the sake of the permanent record it would be well for him to write a few paragraphs on amoebic dysentery. Pain in the back has been discussed repeatedly. I think every committee that has been appointed has had an article on pain in the back. Apparently nobody is going to solve it very soon. There are many views as to what produces pain in the back and this is another contribution. There was also a questionnaire about cardiovascular-renal disease. Former committees have reported on this--and as a result of this questionnaire I have asked Dr. S. R. Slaymaker, who has been teaching cardiovascular- renal disease in Rush Medical College for forty years and has been cheeking on all our eardio-vascular disease on the Milwaukee Railroad, to put down a summary of his observations, and this article on cardio-vascular disease is a result of his observation and his summary of following the men th at he sees repeatedly and, of course, in line with his teachings over many years. Syphilis is also a problem that is with us and the various railroads are working on this problem which will have to be solved in a way th at meets their :it local conditions. t Obesity is a more frequent physical defect than is ordinarily suspected, amounting to about 16 per cent in a series of 8,000 examinations. In order to treat tills condition effectively on the Milwaukee Railroad, we i;' have devised a special diet list which is printed on a folder similar to a time ; table and is headed "Time Table for Reducing and Regulating Weight." When an employee is found who is overweight, he is given this diet with instructions to follow carefully for three weeks and to report his progress. With the means of this special diet, we are able to give the employee an outline of instructions that he can take home and follow and which will pro duce the desired results, if observed in a conscientious way. This time table for reducing and regulating weight is submitted to the Association for whatever use the various roads may see fit to make of it. It can be altered or changed in any way th at the various surgeons see fit. 96 Association of American Railroads D k. F. C. W a r r in g (Western Maryland Hallway): Mr. Chairnmn and Members of the Section: I should like to say a few words in connection with this vision article that, is written in this report. I have heard that the im pression has been gained by a number of the Members of this Section that the idea is to change our records from 20/20, or 20/30 or 20/40, whatever the test, may be, to this percentage business that is listed in this report,. That is not the wish of the Committee nor the object of the article that is written here. W hat this percentage is intended to do is to give the Chief Medical Officer of the railway company, the Chief Surgeon, or Medical Director, or whatever his title is, an idea of the approximate percentage of acuteness of vision of an employee so that he can convey it to his management. In quite a number of instances, especially where a man is aging'; and refractive error cannot be corrected, it is a nice thing to be able to tell your management, that this man has only 50 per cent of acuteness of vision and to tell the employee that he has only 40, 50 or 70 per cent efficiency and induce him to get te tte r glasses to correct, this low percentage of efficiency th a t he has. I have brought with me one of each of the charts of the distant vision. On our lailroad we make our medical examiner make the notation whether the man reads 20/20, which is 100 per cent, or whether he reads 20/60, which is 70 per cent. We don't have him handle the percentage. T hat is all done in the office of the Chief Surgeon. The chart is arranged in the same way with the Snellen notations, with your 14/14 and your 14/21 which is 100 per cent and 91.4 per cent, respectively. In this pamphlet you will note how to attain the percentage of efficiency in one eye. This information is mostly gathered from the Ophthalmology Section of the American Medical Association. They submitted a report along this line to guide the dillerent compensation com missions in developing the percentage of loss of vision on account of injury, but we can use the same thing in our test for acuteness of vision. As I say, this percentage is for one eye. It says, "Percentage near vision." We will take, for instance, a man who reads 14/28 on the Snellen Notation. T hat is 83.6 per cent efficiency. To make it easier to calculate in the rnind, we will say that a man has a near vision efficiency of 80 per cent. We multiply that by two, that is a two-fold value, and then we add his distant percentage of efficiency. We will say his distant vision efficiency is 90 per cent. In other words he would have a total percentage then of 250 and we divide that by 3. T hat would give him 83.3 per cent efficiency of vision in th at one eye. If you get the visual efficiency in both eyes, the good eye has a three fold value. In other words, we will take a man who has lost one eye. llis other eye is 100 per cent. Naturally you would think that he has only 50 per cent efficiency with just one eye, the other one being enucleated, but. that is not the case. You give a three-fold value to the good eye which is 100 per cent. T hat means 300 per cent and you divide by four the three-fold value for the good eye and that gives the man a visual efficiency of 75 per cent, which is a little more than 50 per cent. T hat is my idea in bringing this report to you. This is all American Medical Association work that has teen developed, as I said, by their Ophthalmology Section, and I think it will be a great help to us men. T he Chad, D r . Wisbiv reports and t! diabetes, but ing just what I recently : Department C on diabeim pfor the nddrw surgeons I galook them ovi get the beneie. patient?, are u< to railway , instances, hm regimes. He studying thesi 'File time e transactions, i you, just as y. . . . Dr. T he Chair: 'conclusions. I here for ten ye the handling < CornmitU'C ol 1 . . . rp, that the report Dr. Cardie's g T ue C iiaihv T he C uairv rnittee on Me, make this repo they seemed n has no huskiescized for it, but a great ileal to Dr. Dotvdal! at the Pullm an D r . Ckowhe time ago Dr. I ) report and I to) t: [man and :tion with T the imtion that whatever at. That is written ail Officer whatever ion of an umber of imiut be this man ; that he :r glasses ion. On ither the which is done in vay with per cent 0 attain gathered i. The}' on com1 injury, vision." otation. is mind, nultiply 'cenfage nt. In i divide hat one a three-e. fiis only 50 mt that 100 per d value ?r cent, vledicai Biology i; 1':' { l ' j ? j | |i | f s ;y. Proceedings of Medical and Surgical Section 97 T he Chairman: Is there any further discussion on this? D r. Webb: The question of diabetes has been brought up in the last two reports and this problem has caused me a good deal of worry. I do not treat diabetes, but I read the reports of the committees and I am constantly wondering just what to tell our management about the diabetic cases. I recently asked Dr. A. E. Cardie, who is the director of the Outpatient Department Clinic of the Minneapolis General Hospital, to talk to our surgeons on diabetic problems among railway employees, and in order to prepare him for the address and in order to give him something of the problems of railroad surgeons I gave him our transactions for the last ten years and asked him to look them over and incorporai.e them in his paper, so that our doctors might get the benefit of the transactions and his special knowledge of diabetes. His patients are ah charity patients and in consequence are somewhat comparable to railway employees who are on duty. They may be more difficult, in some instances, but the railroad employee also has difficulty in following diabetic regimes. He recently wrote me a letter expressing his ideas as the result of studying these transactions and also his recommendations. The time is growing late. I should be glad simply to place this in the transactions, in order to let the rest of you have the benefit of it or read it to youT, ujbusCt hasaiyromuadne:sirMe. embers of the Section: You have heard Dr. Cardie's 'Co.ncl.usio. nsD. r.HWe hebasb sruemadmDarri.zeCdaradlliet'isrecownocrlukstiohnast. we. ha. ve. done, on diabetes here for ten years, and his opinion is so different from most of our opinions in the handling of these railroad men that I believe this should go before the Committee of Direction before we incorporate it in the minutes of our meeting. . Upon motion regularly moved, seconded and carried, it was voted that the report, of the Committee be received as a Progress Jteport and that Dr. Cardie's conclusions be referred to the Committee of Direction. . T he Ciiaip.mav: Is there any further discussion on this subject? T he Chairman': The next item on the program is the report of the Com mittee on Medical Aspects of Air Conditioning of Cars. Just before they make this report I want to say that when I appointed this committee last fall they seemed to object to it, they seemed to think that the Medical Section has no business to look into this air conditioning of cars. I was rather criti cized for it, but I insisted on appointing a committee because I think we have a great deal to learn about air conditioning. Dr. Dowdall is not here. Dr. Crowder will tell us about the research work at the Pullman plant. Dr. Crowder: I had no know ledge th at I was to furnish a report. Some time ago Dr. Dowdali called me up and asked me if I could help him with this report and I told him I would be glad to do that. We discussed in what way o. /