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interstate Commerce Commission Utafjmgton, 2B.C. 20423 > I, SIDNEY L. STRICKLAND, JR., Secretary of the INTERSTATE COMMERCE COMMISSION, do hereby certify that the attached is a true copy of the Association of American Railroads Proceedings of the Thirty-First Annual Meeting of the Medical and Surgical Section, held at The Drake Hotel, Chicago, IL, April 2, 1951, the original of which are now on file and of record in the office of said Commission. IN WITNESS WHEREOF I have hereunto set my hand and affixed the Seal of said OF THE THIRTY-FIRST ANNUAL MEETING or THE MEDICAL AND SURGICAL SECTION I PLAINTIFF'S i EXHIBIT i AM-V PROCEEDINGS Of THE THIRTY-FIRST ANNUAL MEETING Of THE Association of American Railroads, MEDICAL AND SURGICAL SECTION HELD AT THE DRAKE HOTEL CHICAGO, ILLINOIS l,APRIL 1951 f ME i \ : *' '.Vr^-V V-'. .* <-..N < \ Assoc IO ( L Coni i) ( -Oil l II Ji` Comm Hf Comm Rr Di Comm Comm; Davis. Eve, D First A Pr- Hi Graham Kiley, J 1 \ INDEX Page .-Worn*ion of American Railroads: Board of Director* Officers . ...... Operations ami Maintenance Department .................... Operating-Transportation Division Officers ................................. 5 5 6 6 Bennett, Richard J., ir.: presenting Report of Committee on Developments Resulting from Physical Examinations................ 55-67 Committee of Direction............................................................................ 8 Committee on Developments Resuming from Physical Ex&mina* tioos ................................................................................................... Report of ................................. 7,8 55-67 Committee on Disability ami Rehabilitation Report of 7 21-4.5 Committee on Fractures ......................... Report of.............................................................................................. Discussion . ..................... 7 78-85 85-89 Committee on Medical Aspects of Air Conditioningof Cars 8 Committee on Nominations, Report of ............................................... 91-93 Davis, William T.: presenting Report of Committee oaNominations 91 Eve. Duncan: presenting Report of Committee onFractures 78-59 First Aid Kits: di-eiK-ion of ... 67-77 Presentation of Proposed Revision of Recommendations on "First Aid Equipment" and remarks by Dr. R. M. Graham 67-70,75,76 Remarks by K. B. Landry (Safety Director, If. S. Post Offico Department) ...............72-74,75,78 Graham, R. M.: Progress Report on Activities of Joint Committee on Railway Sanitation......................................................................... 48-48 Kiley, J. P.: Address at Annual Luncheon ........................................ 49-54 ZKDEX--Continued Page Landry, E. B.: remarks Re First Aid Kits .................................. 72-74,75,76 Medical and Surgical Section: Officers of Section and Personnel of Committees 1950-1951....... Officers of Section and Personnel of Committees 1951-1952 ..... Election of Members to Committee of Direction ....................... Election of Chairman and Vice-Chairman ................................... Representatives attending AnnualMeeting .............................. Rules of Order ........... . ... ... 6-8 94-96 92, 93 93 13-15 9-12 Meta, Arthur R.: Address as Chairman . .. 16-19 Proposed Revision of Recommendations on "First Aid EquipmcnT' 68-70 Discussion 70-77 Sessions of Annual Meeting: Monday morning. April 2 Luncheon Session, April 2 Monday afternoon, April 2 16-54 48 54 Stack, James K.: presenting Report of Committee on Disability and Rehabilitation......................................................................... 21-45 *r IV ASSC W. T. I a J. Carter J. H. Aye: Walter J. E. H Bun; Depar J. H. Par. ics). Robert S. G. M. Car W.T. Fan C. McD. I J. D. Farr. .^-.Walter S. j E. S. Freii: F. G. Cur! Topek P. W. Job: W. A. Joh: J. P Kile \ R. S. Mac: A. T. Merc G. Metrma P. J. Neff, Ernest E. JL. R_ Powe A. E, Stodd Roy B. Wl. Wm. White ASSOCIATION OF AMERICAN RAILROADS (April, 1051) 0 fleets W. T. Faricy, President. J. Carter Fort, Vice-President and General Counsel (Law Department). J. H. Aydelott, Vice-President (Operations and Maintenance Department). Walter J. Kelly, Vice-President (Traffic Department). E. H Bunnell, Vice-President (Finance, Accounting, Taxation and Valuation Department). J. H. Parmeloe, Vice-President and Director (Bureau of Railway Econom ics). Robert S. Henry, Vice-President (Public Relations Department). G- M, Campbell, Secretary-Treasurer. Board of Directors W. T. Fariey, Cliairrnon (ex-officio). C. McD. Davis. Prrddf-nt, Athntic Coa^t Fine Railroad. ). 1). ; Pr-wd'iit. ('Ih-mim. Rwk f'l.tncl it Pacific Railroad. Walter 3. I'ranklm, l*ri.i-n(. Pennsylvania Railroad. E. 8. French, President, Boston A Maine and Maine Central Railroads. F. G. Gurley, President and Chairman of Executive Committee, Atchison, Topeka & Santa Fe Railway. P. W. Johnston, President, Erie Railroad. W. A. Johnston, President, Illinois Centra! Railroad. J. P. Kiley, President, Chicago, Milwaukee, St. Paul A Pacific Railroad. R. S. Macfarlaoe, President, Northern Pacific Railway. A. T. Mercier, President, Southern Pacific Company. G. - Metxman, President, New York Central System. P. J. Neff, Chief Executive Officer, Missouri Pacific Lines. Ernest E. Norris, President, Southern Railway System. L. R. Powell, Jr., President, Seaboard Air Line Railroad. A. E, Stoddard, President, Union Pacific Railroad. Roy B. White, President, Baltimore A Ohio Railroad. Wm. White, President, Delaware, Lackawanoa A Western Railroad. 5 6 Atsecialum 0/ American Railroad* OPERATIONS AND MAINTENANCE DEPARTMENT J. H. Aydelott, Vice-President OPERATING-TRANSPORTATION DIVISION F. A. Dun-son, Chairman R. C. Parsons, Vice-Chairman L. R. Knott, Executive Vice-Chairman OrriCERS AND PERSONNEL OF COMMITTEE8 OF THE MEDICAL AND SURGICAL SECTION FOR THE YEAR 1950-1951 Dl . A II. Ml I 1 `Jl.'i i Vll r./ |l "D. Knl'-r Sa:i<-i-, V i i-i- I't 1111.a j: J i. > 11. Ini 1 . s.-.-1 i-r a 1 \ Committee of Direction I r. . II. Mil/. 1 1.:, 11 a .. t*l>i. Culler \aix-. V ii i- < 'li.i i nn.'i n ( T< 1 in 1 \ (>i 11 > in 11'.`. I 1 1 >i. I >11111 a 11 Jr, < Mi ii-f Su rgci-n, X.isIm i Nr, CI1.111 a nonga A K|. Louis Rail, way, Nashville. Temi. Dr. R. M. Graham, Director, Department of Sanitation and Surgery, The Pullman Company, Chicago, Illinois. I*r. <1. 11. Uorratl, Chief Surgeon, Chicago, Burlington A Quincy Railroad, Chicag... 1 llicojs. Dr. A. K. Metz., Chief Surgeon (Lines East , Chicago, Milwaukee, SI. Paul & T'acilic Railroad, Chicago, Illinois. (Term expires in 1952) I>r. M. B. Clayton, Chief Surgeon, -Southern Railway System, Washington, J). C. Dr. K. K. Dowd, Chief Medical Officer, Canadian National Railways, Mon treal, Quebec, Canada. . Dr. T. L. Hansen, Chief Surgeon, Chicago, Rock Island and 7`acitic Kail road, Chicago, Illinois. J'r. .7. Huber Wagner. Chii f Surg,-on, Hessi no-r and Lake Erie Railroad, 1 (1'JT Cnrnogi" Bldg.. l'ittslmrg!i 19, Pennsylvania. - Ti mi t \pir-s ji; '> Dr. II. -I. Bciitu 11, Jr.. Chil l' Surgeon. Elgin. -Joliet A Eastern Railway, South La SnlL Street, Chicago, Illinois. I>r. A. M. W. Jlursh, Chief Medical Esamiucr, Pennsylvania Railroad System, 35 North 32nd Street, Philadelphia 4, Pennsylvania. Dr. W. E. Mishler, Chief Surgeon, Erie Railroad, 608 Republic Building, Cleveland 1, Ohio. Dr. Fuller Nance, Medical and Surgical Director. Baltimore and Ohio Railroad. Baltimore 1, Maryland. (* Retired from active service effective February 1, 1951.) Dr. James i Railwa Dr. T. L. B 139 \N\ Dr. W. W. Island Dr. W. W. \ Depart: Dr. O. }{. Y. M rsn-ii ' Advisory M< Di. I;. .1. }; 1'0>> Hon i Dr. R. M. ( Pullman Drive, C. Dr. C. C. Guy, Chicago, Dr. O. U. Hot 54 7 West Dr. R. B. Kc; Railroad, Dr. A. R. Me waukee, S I>r. Duncan F St. Louis Dr. Ralph G. ( Pacific Ra Dr. C. i\ Hv.ltGeorgia. Dr. B. W. Stock Detroit, M. Dr. J. Huber V 3027 Came; C. Dr. R. J. Bonnet Railway, 2v uis 'v. T.. r.i! St. l':iul dmigtot*. . M- 1. R ul Railroad, Kailway, Railroad A 1`roceeiiini7.1 oj Medical and Surgical Strlion 7 Committee on Disability and Rehabilitation Hr. Janus K. sia'k < 'h.inman), Clucf Surgeon, Chicago & North Western Railway, i_7 North Clinton street. Chicago t>, Illinois. i>r. T. L. Il.utdt'ii, Chi*-1" Surgeon, Chicago. Rock Island St Pacific Railroad, 139 West Van Huron Street, Chicago 5, Illinois. hr. W. W. Leake, Chief Surgeon, fllinois Central System, 380U Stony Island \venue, Chicago, Illinois. Dr. W. W, Wa.'lil'urn, Chief Surgeon, Southern Pacific Company, Hospital Depar'iuenl, lion t\* 11 street, San Francisco 17, California. Dr. (). It, Zeinert. Chief surgeon. Miw.uri Pneifie Railroad, st. Louis, M i*vni ri, Advisory Members Dr. B. J. Bennett, Jr., Chief Surgeon, Elgin, Joliet Sc Eastern Railway, 208 South La Salle Street, Chicago, Illinois. Dr. B. M. Graham, Director, Department of Sunitatiou and Surgery, Pullman Coinpauy, Merchandise Mart Plaza, 222 West North Bank Drive, Chicago 34, Illinois. Dr. C. C. Guy, Chief of Surgery, Chicago Hospital, Illinois Central Railroad, Chicago, llliuois. Dr. O. II. Horrail, Chief Surgeon, Chicago, Burlington & Quincy Railroad, 347 Went J.iekioti BouU-vird, Chicago *>, Illinois. Dr. K. B. Kcpuer, Chief Medical Otticer, Chicago, Burlington ic Quiuey Ruilroa<l, *17 West Jackson Boulevajw^ Chicago i:, Illinois, Dr. \. R. Me!/. (.* oilien. >. Chief `'ini'i'.ii 'lanes K.isH, t'ho.igo. Mil waukee. St. Paul \ Pacific Uailin.i.l, Chicago, Illinois. Committee on Fractures Dr, Duncan L . Chairi'i ai , c|;;. i -iirgiou, \a*h\i!!o, < lia't ano.ig : a. St. Loins Railway, .'""l II. >,rr,i, Ni-Juillv t. Ten mo,,,,.. Dr. Ralph C iruthcrs, * L' s<n ,,'.>, * up inn.it i, New Orleans cc 'fes.is Pacific Railway, Cineinnal i Ohio. Dr. C. P. Holton, Chief Surgeon, Central of Georgia Railway, Savannah. Oeorgia. l)r. B. W. Stoekwoll, Chief Surgeon. Del roit !; Toledo Shore Lino Railroad. I Detroit, Michigan. Dr. J. Huber Wagner, Chief Surgeon, Bessemer & I.ake Erie Railroad, 1027 Carnegie Ltldg,, Pittsburgh 19, Pennsylvania. Committee oa Developments Resulting From Physical Examinations Dr. R. J. Bennett, Jr. (Chairman), Chief Surgeon, Elgin, Joliet & Eastern Railway, 208 South La Salle Street, Chicago, Illinoia. Arauciofion 0/ American Railroad Ur, J. J. Braudabur, Chief Medical Examiner, Chesapeake k Ohio Railway, Huntington, West Virginia. Dr, B. 1. Perauf, Chief Burgeon, Northern Pacific Railway, St. Paul 1, Minnesota. Dr. O. H. Ilorrall, Chief Surgeon, Chicago, Burlington 4c Quincy Railroad, 5-17 West Jackson Boulevard, Chicago 5, Illinois. Dr. K C. Walden. Suiierjotenderit and Medical Director, Relief Depart- uuut. Allantn l.im- Railroad, Wilmington, North Carolina. Dr. It. S Westline, Chief Surgeon, Cliieogo A: pastern Illinois Railroad. .'i.U West I Mm I. Chi.-ng", Illinois. Advisory Members Pi. R. M. Graham, Dne* tor, Department of Salutation and Surgery, Tin* Pullman Company. Mi r < ha ih| ise Mart, Chicago 54, Illinois. Dr. C. t '. Guy, Chief of Siiik'-i.1 . * 'hieago Hnspit a I, Illinois Central Railroad, Chirugn, Illinois lir. Jf, Householder, Assistant Chief Surgeon (l.ines Kust), Chicago, Milwaukee, St. Paul 4c Paeilie Railroad, Chicago, Illinois. Dr. W. W. Leake, Chief Suigooii, Illinois Central System, 5800 Stony Island Avenue, Chicago, Illinois. Dr. J. K. Stack, Chief Surgeon, Chicago k North Western Railway, 127 North Clinton .Street, Chicago 6, Illinois. Dr. A. K. Metz (ex ofticio), Chief Surgeon (Lines East), Chirago, Mil waukee, St. Paul k Pacific Ruilnml, Chicago, Illinois. Committee on Medical Aspects ot Air Conditioning of Can Dr. R. M. Graham. (ChairmanIwrfJireetor, Departrm-ut of Sanitation and Surgery, Pullman Company,Werehaniiise Mart Pluzu, 222 Weal North Bank Drive, Chieago 5-1, Illinois. Dr. M. B. Clayton. Chief Surgeon, Southern Railway Sys., 15th and K Streets N.W., Washington. P. C. Dr. Charhs B. JYnwjrk. Chief of Medical Services, Canadian Pacific Railway, Windsor Station, Quel.ee, Canada. Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation I)r. R. M. Graham, Director, Department of Sanitation and 8urgery, Pullman Company, Chieago, Illinois. Dr. M. B. Clayton, Chief Surgeon, Soiilhern Railway System, Washington, D. C. Dr. A. M. W. Hurah, Chief Medical Examiner, Pennsylvania Railroad, Philadelphia, Pennsylvania. AS 1. I. repre* CJiir-f E\pr< in this 2. A folia!-1 1*t tlr memb< 3. Tl and Se i VI' fro: ma ( Of ! to l)- l.< : .W fou shn T Dircio* Con ]i. Bin him and men mu Railway, st. Paul 1, .y Railroad, lief Depart< 'a rolina. .a R.niri>al, 'urgery, The is. cal Railroad, t), go, .1300 Stony toil way, 1-7 hieago, M ii- f Cars utatiuii .md WY-if Ni.rtli 1'th and K dian I'aeilie an the >nl Surgery, Washington, ia Railroad, <* Proceedings of Medical and Surgical Section 9 ASSOCIATION OF AMERICAN RAILROADS OPERATING--TRANSPORTATION DIVISION 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 3 Express Agency, Inr., 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 affiliated member thereof upon the approval of his application by the Committee of Direc tion. 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 odinT* of the Section -hall consist of a Chairman, Vice-Chairman and Secretary. Ah provided in the Plan of Organization, the CHAIRMAN and 'VICE-CHAIRMAN shall be -. lis ted by the Committee of Direction from its membership. Their ir-rms of office -hall l>c one year. A Chair man wdl not succeed himself. fh) The SECRETARY will be appointed by tfie Oonor.il Committee of the Division. lli< salary -hall be named by that Comrni'tee, -object to the approval of the Vicf.-Pre-.dvnt, Operations and Maintenance Department. < f<*> The COMMITTEE OF DIRECTION will consist of twelve mem bers, territorially representative is far as practicable--one each from Xew England ami Canada; four from the East; two from the South and four from the West--elected as hi-mnafler prescribed, each of whom i. shall serve for three years. The terms of office of all elective mcmliera of the Committee of Direction shall expire at the com lu-ion of the annual meeting. Vacan cies in the committee mecnljership shall be filled by appointment of the Committee until the next election. In addition to the above, the Surgeon-General of the Uuited 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 Committee of Direction. .-r- 10 Association 0/ American Railroad* 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) Hie 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 Commillee on Medical Aspects of Air Conditioning of Cars. The representation of member ma<b* <m these committees will W, so fat as is practicable, territorially selected, in approximately the same pro portions as that of the Committee of Direction, personnel to be named cadi year by the (.'ornimlloo of Direction unmodiub ly following adjourn ment of the ammo! nicvlmg. Duties 0/ Officers 4. 'J he CHAIRMAN shall have genera) mjjxtvimmi over the affair* of the Section and shall preside itl /nof-tingr. of (he Section ami ul meeting-* 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 l>e assigned. 6. (a) The SECRETARY sliall perform the usual duties of that office and such other duties as may be assigned to him by the Chairman. (b) He shall receive six weeks in advance of (he annual meeting each year the report of the Committee on Nominations, as elsewhere provided for, and will submit to the membership at the annual meeting the nomina tions contained in that report, to fill the vacancies in the membership of the Committee of Direction. He sliall 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 interest* and affairs of the Section. (b) lie empowered to net on behalf of (In- Section in the interim Ix-twvcn meeting? and shall submit at each meeting a report covering its actions. (<*) Examine and decide what jxirti-m of roinnnini'-ation.*, pajK-r* and reports shall lx- submitted al tie- n>-< ting*, h sliall ii**lerinine winch, 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 00 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 culled for by that official. (g) Call annual meetings of the Section, subject to the approval of the General Committee of the Division, if in its judgment conditions warrant. (t to ea requ 8. The sliall repc ing of ea* place the year, and The d_ 9. CO.* REHABi: tn<0'. oil ni iicv of rdiabihtu'. lion of fin 10. C0 ` study and ing fa) L (c) Fractu similar sub 11. CO.' RESULTI.' report, wr periodic e' warrant, t: as the fon; 12. CO.V OF AIR CC 1 Lx relation piirtments 13. V07 viva voce, entitled to * shall be n*<. ordered. ( Direction s: officer will l 14. LETT Committee property. T ownership t mberahip Ifire shall % 3: I A.inuna- <i <' i:s. . he. <o tai U1H` 1>T0- named ; adjnurn- lire of the iC3 < -i U and ting each provided " nomina* jorship of u `.lection . f_. .rs "f the n between i actions. i|XT3 and which, if o referred rh year a ; member of COQ.e Section val r' wat Proceedings of Metlicnl and Surgical Section 11 (h) Call meeting* of the Section, ujkhi not less than thivlv days' not tee to each member. It must call special meetings of the Section upon the request, in writing, of a majority of the memlier ruads. 8. The COMMITTEE ON NOMINATIONS, appointed as above prescribed, shall report to the Secretary at lenat -ox weeks in advance of the annual meet ing of each year, at Iea.it two nominations for each impending vacancy to re place the four members of the Committee >t Direction whose terms expire that year, and to till any vacancy. The duties of tin; Standing f `omrriittecs shall be as follows: 9. COMMITTEE NO. I --The COMMITTEE ON DISABILITY AND REHABILITATION shall study and rejHirt. with siiggestion.s or nvouunecidalions, on such subjects that have to do with the physical eliicieucy or inelliciency of railroad employes. It shall also consider ways and means for the rehabilitation of injured or incapacitated employes and the complete restora tion of function. 10. COMMITTEE NO. 2--The COMMITTEE ON FRACTURES shall study and rejjort on the treatment and transportation of fracture cases includ ing (a) Diagnosis of fractures, (bj First aid and transportation splints, fc) Fracture report forms, id) X-ray work in connection with fractures, and similar subjects. 11. COMMITTEE NO. 3-The COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS -d.ail analyze and make report, with rccommcndaiions -it -Mgg.items, on data made available by periodic examinations, etc. It shall study and revise as conditions may warrant, the recommended -iruidards covering physical examinations as well as l he forms used in ni.ee ! mu i h< n-'.i h h. 12. COMMITTEE NO. 4--The COMMITTEE ON MEDICAL ASPECTS OF AIR CONDITIONING OF CARS -hall study and report on this subject in its relation to the health and comfort of travelers, cooperating with other de partments handling matters relating to air conditioning of equipment. 13. VOTING AT MEETINGS OF SECTION: (a) Vote may be taken viva voce, by rising, by roll call or by ballot. Each member road shall lie 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 wiU be recognued 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 roada shall be proportionate to the ownership of miles of road. Approval of minutes of last meeting Reports of Standing Committee* Rcjjort* of S|jeciol Committee Reports of Teller* Unfinished Business New Business 1C. Robert's Itulcs of order shall govern the proceeding1! of this Section, including amendment to these Rules of Order. t I Bali Ri. Balt Ban. Belt Beas> BoatCaot. Can* Cent Cent Cent Ches Chic Our ChlCi Chics roa Chics Pa* Proceeding! oj Medical and Surgical Section 11 ASSOCIATION OF AMERICAN RAILROADS MEDIOAJ* AND BtJBOICAL SECTION Drake Hotel, Chicago, lIlinoi.<. April l. 1951. The following were present: Member* Representatives * Baltimore 4 Ohio Chicago Terminal Railroad ..............................................Dr. S. M. English, Medical and Sur gical Director. Baltimore 4 Ohio Railroad................. Dr. 3. M. English, Medical and Sur gical Director. Bangor 4 Aroostook Railroad........... Dr. II. 0. Bundy, Chief Surgeon. Belt Railway Company of Chicago... Dr. R. S. Westline, Chief Surgeon. Bessemer 4 Lake Erie Railroad........ Dr. J. Huber Wagner, Chief Surgeon. Boston 4 Maine Railroad.................. Dr. J. R. Knowles, Chief Surgeon. Canadian National Railways............... Dr. K. E. Dowd, Chief Medical Offi cer. Dr. Emmet Dwyer, Regional Medical Officer. Canadian Pacific Railway ..................Dr. C. P. Fenwick, Chief of Medical Services. Dr. G. Earle Wight, District Medical Officer. Central of Ceorgia Railway ...........Dr. [ra Goldowsky, Medical Director. Central Railroad of NVw Jersey Dr. Ira GolJowdty, Medical Director. Central Vermont Railway .............Dr. K. F.. Dowd. C'hitf Modiml Offi- i-cr. ('hc-apeake 4 Ohio (IVre Marqu-!tei Dr. J S' A-linc, Medical Director. Chicago A Eastern Illinois Railroad Dr. R S. Cim f Surgeon. Chicago 4 North WV-.tern Railway. Dr. .1 K. Stack, Chief Surgeon. Dr. A. Xygood, Chief Medical Exaroi- aer. Dr. W. H. I.ongworth, District Sur geon. Chicago 4 Western Indiana Railroad Dr. R. S. Westline, Chief Surgeon Chicago, Burlington 4 Quincy Rail road ..................................................... Dr. 0. H. Horral), Chief Surgeon. Chicago, Milwaukee, St. Paul and Pacific Railroad............................... J)r. A. R. Meta, Chief Surgeon. Dr, James F. DePree, Chief Surgeon. Dr. W. H. Longworth, Local Surgeon. Dr. A. N. Altringer 14 Attooiation of A mericon Railroad Unn^n BepreMnUtlTM Chicago, Rock Island 4 Pacific Rail road .....................................................Dr. T. L. Hansen, Chief 8urgeon. Dr. A- N. Ajtringer. Cincinnati, New Orleans A Texas Pacific Railway ................................. Dr. Ralph G. Carothers, Chief Sur geon. Colorado A Southern Railway......... Dr. W. J. Longrway, Chief Surgeon. Dr. IV. IS Hardeaty, Medical Director Cleveland, Cincinnati, Chicago A St. Louis Railway ........................ .......... Dr Win H Norman. Chief Surgeon. Delaware, Lackawanna A Western Railroad ............................................ Dr. Wm. T. Davis. Chief Medical Offi cer. Detroit A Toledo Shore Liue Rail road ..................................................... Dr. B. W. Stockwell. Chief Surgeon. Elgin, Joliet A Eastern Railway......... Dr. R. J. Bennett, Chief Surgeon. Erie Railroad ........................................ Dr. W. E. Mishler. Chief Surgeon. Fort Dodge. Des Moines A Southern Railway............................................... Dr. W. H. Longworth, Chief Surgeon. Grand Trunk Western Railway........... Dr. K. E. Dowd, Chief Medical Officer. Dr. B. W. Stockwell, Chief Surgeoo. Illinois Central System........................ Dr. Wm. W. Leake, Chief SurgeoD. Dr. Chester C. Guy, Chief of Surgery. Dr. R. L. Bill, Local Surgeon. Indianapolis Union Railway..................Dr. W'ro. B. Norman, Chief Surgeon. Kansas City Southern Railway............ Dr. A. N. Altringer. Louisville A Nashville Railroad............ Dr. Duncan Eve, Chief Surgeon. Maine Central Railroad......................... Dr. J. R. Knowles, Chief Surgeoo. Minneapolis, St. Paul A Sault Ste. Marie Railroad....................................Dr. Harvey Nelson. Miasouri-Kansaa-Texaa Railroad........ Dr. Roland S. Kicffer, Chief Surgeon. Dr. W. A. Bowersox,Division Surgeon. Dr. L. 8. Willour, Local Surgeon I)r Clyde P. Dyer. Muwoiin Pacific Railroad .......... I)r. O. H. Zvitu rt. Chief Surgeon. Montour Railroad ................................. Dr. Harold G. Kuebmer, Chief Sur geon. Nashville, Chattanooga A St. Louis Railway................................................. Dr. Duncan Eve, Chief Surgeon. New York Central System................... Dr. Wm. H. Norman, Chief Surgeon. Dr. J. N. Aaline, Medical Director. Dr. E. R. Murbach, Company Surgeon. New York, Chicago & 8t. Louis Rail road ......................................................Dr. John W'. Ilouk. Medical Director. Norfolk & Western Railway..................Dr. B. E. Tophara, Medical Director. Northern Pacific Railway......................Dr. B. I. Derauf, Chief 8urgeon. Panhandle A Santa Fe Railway .......... Dr, Stoncwal J. Montgomery, Surgeon. 4 Pennaylv Pullman Reading t St, Louic- Louis ' Southern , Texas A > Virginian . Wabash II Association Railway Ag Tested Apr Surgeon. Chief 3ur- Surgeon, d Director f Surgeon. lo<licnl Offi- Surgeon. urgeon. urgeon. ef fc 'o. ':cal 0. urgeon. surgeon, of Surgery, on. f Surgeon. zeon. irgeon. Proceedingt of Medical and Surgical Section 15 Members Representatives Pennsylvania Railroad Dr. A. M. W. Hursh, Chief Medical Examiner. i Pullman Company . ... Dr. R. M. Graham, Director of Sanita S tion and Surgery. Dr. Lloyd M. Markley, Chief Medical l Examiner. Reading Company ....................... ..Dr. A. Neupauer, Chief Medical Offi cer St. Loui$-33ii Franci.*co Railway Pr. V. W. Hollo, Chief Surgeon. Dr. R. L. Hill, Local Surgeon. Dr. A, N. Altringer. St. Louis Southwestern Railway. JDr. W'm. Hibbilts, Chief Surgeon. Southern Pacific Company......... .Dr. Wm. W. Washburn, Chief Surgeon. Texas <fe New Orleans Railroad. .Dr. J. R. Gandy, Chief Surgeon. Virginian Railway....................... J)r. Southgate I^eigh, Jr, Chief Sur geon. Wabash Railroad......................... .Dr. W. E. Oollings, Superintendent Hospital*. Also Present Association of American Railroads . H. S. Dewhurst, Secretary, Medical and Surgical Section. Railway Age Magazine.......................... \. M. Cox. Jr.. Associate Editor. Tested Appliance Company..................A. K. Frey : Surgeon, u SuigeOQ. g<un geoo. Chief Sur geon. Surgeon, rector, y Surgeon. I Director. Director, con. Surgeon. -wi r,< w *7* 16 Atsodadon of American Railroad* FIRST SESSION Monday Morning, April 2, 1951 The Thirty-first Annual Mooting of the Medical and Surgical Section. Association of American Railroads, convened at 9:30 o'clock at the Drake Hotel, Chicago, Illinois, Chairman Arthur R. Meta, Chief Surgeon, Chi cago. Milwaukee. Si. 1`atil and Pacific Railroad, presiding. Tin Cuuumsx <;> niImh< ii. tlii'- im rtjug j< the Thirty-first anniver-aiv (,{ ilu iiiKamzaimu id lj> Mii<-:tl and Surgical Section of the 0[*erat ing-Ti ati-;>ori at ion Divi-ion. As-ociation of American Railroad.*. Tin A"Oi-i.iiuii. oi Ain' ii' an K.iilro.id' i> the organization of tlie prin cipal railroad' of ihr 1'nited State.-. Canada and Mexico, for dealing with mailer- of mininon concern m the whole field of railroading. The Article5 of 0ignUi7.nimti of tin A.....iiimii read a* follows; "It? object is, by recommendation. to harmonize and co-ordinate the principles and prac tices of American railroad- with re-pn-t to their construction, maintenance and operation." The Association is the "lineal descendant" of such earlier organisations as the Time Conventions formed in 1872, and the General Time Conventions, which, in 1883, established the system of standard time by which the whole nation now lives; the Master Car Builders' Association, formed in 1867, which established the standardization of freight cars, this making possible their free movement from railroad to railroad throughout the country; and the Railway Accounting Officers' Association, formed in 1888, which helped to develop uniform railroad accounting and other similar organiza tions. These and numerous other organizations of railroad men working together for the better performance of the railroad-' job of transportation are now part of the Association of American Railroads, which was created bv the merger in l (KM of I hr American Railw.iv Association, the Association of Uaihvav Executive-, the Itailway Accounting Officers' Association, fl?f- Rail way Treasury Officer-' Aonulmn. tin- bureau of Railway ICmiioniic''. and other organization'. Mi R 1! Ai-hiiin. i'le.-ul.n; of ilu American Railway Association, nn Noveiul,11 (i. 1`i^n a iriiig(Irai v ('urnin111ee of Direction of the Medical and Smgic:d >tciioii. wim-. ilmv u wa- to mganize the Section, elect lemj.oian officer- and .upem-e 11 Section'' arliviiie- until such time as the Section might formally elect its suerrs-m-. The first mei iing of (lie Committee of Direction wa> field in New York on Decrnihcr 1. 1920 and elected officers and adopted tentative regulations to govern its activities, Thi' refolds how the following to be the original appointed members of the Committee ,,f Diie/uion : Ph. D. /. Pi nott f( hanman). Chief Surgeon. Western Maryland Rail way. Baltimore. Md Dr. G. G. Dowd.m.l (First Vice-Chairman), Chief Surgeon, Illinois Cen tral Railroad. Chicago. 111. Proceedings o) Medical and Surgical Section 17 Ds. Duncan Eve (Second Vice-Chairman'). Chief Surgeon, Nashville. Chattanooga 4 St. Louis Railway, Nashville, Teno. Dr. C. W. IIopki.ns (Third Vice-Chairman), Chief Surgeon, Chicago & North Western Railway, Chicago, III. Dr. William B. Coley, Chief Surgeon, New York Central Railroad, Now York City. Die. T. It. Ckouukk, Dinn-lor, Dept, of Nauu.iiion and Surgery. Tin: Pull- man Company, Chicago, III. Dit. H. S. Ccmmiyo. Smgci.n C Lr\-i .el. Bur< ao of The Public I!e:t)tli Si cue'. W '-'i.SigloU, I). r. Dr. A. W. Fiiikmin, Cniium.-doner <f llralih, Slate Department of ll' iltli, Columbus, l). f (' pie-< iihJig Stale and Territorial Health Ofiirora' Association). Dr. Robert J. Craves, Chief Surgeon, Boston 4 Maine Railroad, Con cord, N. H. Dr. J. A. Hutchison, Chief Medical OHiecr, (<r.unl Trunk Railway Sys tem, Montreal, Qudjcc. Dk. A. W. Iue, Chief Surgeon, Northern Pacific Railway, Brainerd, Minn. Dr. A. F. Jonas, Chief Surgeon, Cnion Pacific Railroad, Omaha, Nt-Wr. Dii. J. P. Kastkr, (.'hief Surgeon, Atchison, Topeka 4 Santa Pi: Hallway, Topeka, Kan. Da. ft. W. Knox, Chief Surgeon. Southern Pacific Lines, Houston, Tex. Dk. Sjh tiioatk I.mom. ('hief Surgeon. The \ni.m Railway, Norfolk, Y:v. Du. S. C. Pi.fM.MKR, ('hief Sunreon. ('hir.ig.i, R<..-k (dand 4 Pmilic Rail way, Chicago, ill. Dr. J. B. Walker. Surgeon, Penn.-ylv.uii.i System, New York City. The lim general meeting of the? Section was luld in Boslyn, Mass, on June 3-4, RfJI w!n-:e a numher of piomim nf .-peak, r- were on the program. An .uHi'-v- of Peters, i.niKi' -v.m :ueh- I v ':< M.iv.r ( Hun. A. J. Mr. ft. ii. Aiehtou, President of the A-.-oeiatinn. outlined tlie objectives li.r 11 ,<* Mcilaai ,i..d Sotgied ''<<',11 .'.i j 'ii D !. . i| ('iuiuiu:ig uf lie- l'm:''l >' !'- Put.: ' I (a!1 h > i \; g i \ i oil, <( . uig <tf i : !> ;< iit- ir<<ni's I'fnh-tvoniig to <-<)-<(-iati' Tin' tit -1. < '! < a m ui, Dr. D. Dtuiolf. <'i<e f Sui iti'iii, W< Mi.'.Dti-l Ri.iv.iv, u. -! < ., ry c\t-ti-ive report and gave. Miggcstioiv* for uig.inuaiion .<ad nperit.r.g tiie Section which were adopted. Annual meeting* of the S-chun A<r<- :.< !d regularly until 1042 when oq account of World Wir II no meetings Were held mud 1946. On October 28, lUUi, the general meeting of tin? Section was resumed at which time new ollicrrs ami Coiumitii'o of Direction were elected and meetings have lnvn held annuallv luvr since. Inasmuch as the personnel rejiresenting dm member rntuls has changed, many of whom are not familiar with the curlier work of the Medical and Surgical Section, it was deemed advisable for (his year's annual meeting to make an extensive review of (he proceedings during the past thirty years and abstract the important points that have been discussed and bring our various committee report.* up to date. The Committee on Disability and Rehabilitation has consumed a great i? fife3^Vr* --i r/rtwa ffiti 18 Aigociobon 0/ American Raiiroadf deal of lime of the member? of the committee, m addition to a group of advisory members, who have held a aeries of six meetings, and have reviewed the recommendation? so that we are now presenting in abstract form the high points that have boon discu^-cd in the past with the hope that il will make easy reference to the new members of the Section. In a similar way, tin- Commit lee on Developments Resulting from Physi cal Examination.- ha- rrvi.-rd am! brought up lo dale il- rcpoi I which 1 being pre-r Med for your eon.-idr ral ion. A special commitK-e on J ei Aid lii.-tru'-iions for Railroad Employeha.-- also revi.-i d the Imohbt whirL ha-- bei-n btought u;> to date and Will be avuiiabl. ;i- -ouu a- |: 11 * 1. Reconma ndeii Standard ib.e-'iec ,t. to Fir.-; Aid Training and Equipment (Circulni M. iV S.-j!) ha- ovi-id -n a- tfi eoniorm with present day c-quipim ni In oilier word- 'lie pre-enr Committee of Direction and the various committee- him hem \.jy n'tnr during ih- pa-1 year in abitraclitig ami bring.ng a; do- d.- m t:>v -object- which have been di-ciK-ed during the past thirty year.-. We hope liiai von will appreeiale lli.-it many of the mibjccl.M discu-wd rould lx- t ulaig'-d upoii but our object 1- to it ill us brief and abi-tra'l form as |<>--il* ..nd that the-, are mr-<ly r- i-nnuiH ndalioiis to be used a- a guide f.,1 (he Midie.il and .Surgical f)ep.irtinenl.- of tin- member road* to follow a- ti appln-.- to their retjmreinfUL-. The Medie.il and .Surgical .Section has Ixn-n organized for thirty years and has served a very important position in the o|x;ration of the Associa tion of American Railroad- of vhir-h there is now n total member.-hip of 13C. The repre^entaiive- of all the Mcmhet Road- of the As.-oc.itiiiou of Ameri can Railroad- are urged to take an active interest in this Section and to enter into free di.-cu.-.don of the various problems that are presented and also to work on committee.- lo which various members are asked to serve. The preset Chairman has had the pleasure of serving as Chief Surgeon of the Milwauk.e Railroad for the p:i.-i twenty-three years and has had the pleasure of being a member of tin- Committee of Direction for the past sixteen jva: --. It is inieiimg t<* note tn.it in my (.'hairninu's addre-s of October 2S. 1WC, I iccommciuh-d that all important .-object.-' be brought up to dale and lo include- the new developments in medicine and surgery and re marked at that time that it would take considerable work but would serve as a good text for the Section. This meeting five years later is presenting the result of this work that wa- originally recommended five years ago. During the pa-t year the oilier of the Medical and Surgical Section ha* Ix-cn movi d fiiiin New \ in k to ( Im-ago. 1-roin the time of the organization until coming into ( Imago, Mr. J. ('. Cavi.-tou was Secretary, during which time he helped direct the Section in a very able manner and those of us who have had the pmilegr of working with him miss his presence, but ho has trained for the Section a good Mieee.-v-or. Proceedings of Medical and Surgical Section 19 Our new Secretary, Mr. H. S. Dewhurst, who was appointed June 1, 1950 to .succeed Mr. Cavi.-ston, is now in Chicago where the general offices of the Association are now located. Mr. Dewhurst has cooperated with the various committc-es being present at all their meetings. His services have added murh to (he mmmittres in getting up reports that are now being pre.-ented. The S.-.-i un <-m rmi-.drr d-<tf to lie very fortunate to have -.iii.-h a couij-i r< nf. .uul `'oopt iMiive Secretary 'o carry on the work. I am competing my .-ixrh v<vir i>- Chairman of the Committee of Direc tion and wi-li > -n j-r - - mv -iiK'-re ap[o''i`iaiioii of ihe many years of line inmid.-hip and that f liavo enjoyed and I extend my best wi.-hc.* tliat tl.<- work will ).< carried on for ihe common interest of a!! rail road*. (Applan-.d RECORD Or ORGANIZATION AND MEETINGS Year OF THE ASSOCIATION 1920 Dee. I--D. Z. Dunott--Chairman--Committee of Direction--New York Organization meeting with temporary Committee of Di re.-hor) and election >f officers with adoption of tentative regulations lo govern the activities of the Association. Date Chairman Place of Meeting Hotel 1921 1922 1023 1924 5925 1926 1927 192S 1020 !': 1931 1932 1933 1034 1035 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 D. Z. Dunott D. Z. Dunott G. Ci. Dowds]) for D. Z. Dunott (I.O. Dowd*! O. 0. Dowdall J. .Ij. Bower W. H. Bohart W.H.JM.irt L. A. Kn-mmger S f\ I'hnmmK. V. Mifholland C. W. Hopkins John McCombs VV. L. Hartman J. H. Nilsson J. R. Garner D. B. Moss No Meeting Duncan Eve Harvey Bartle W. J. Lancaster A.R. Met* ] A. R. Met* A. R Met* A. R. Met* Boston. M i.-s. *>f. Louis. Mo. San Francisco, Cal. Hotel Westminster Hotel Statler Hotel St. Francis fine .go. III. Atlantic (`itv. X. J. Da!):r.*p TcX. Richmond, Va. (>m l>< (' m. Whin-Sulphur Spring-'. W. V i Hdo\j, Mi-\ Xew York. X. Y. X- ivYork.X. Y. < 'hi. ago. III. W.whington, D. C. Atlantic City, N. J. Chicago, 111. Atlantic City, X. J. Depression Chicago, III. New York. N. Y. Montreal, Can. ('onsnva Hotel Chalfonte Hotel Adolphus Hotel Jr-fTerinn Hotel * 'liatr au Fronienac Hold < iro.'nbricr Hotel Kdimwater Gulf Hotel Pennsylvania Hotel Pennsylvania Hotel Stevens Hotel Hotel Washington Haddon Hall Stevens Hotel Traymore Hotel Stevens Hotel Pennsylvania Hotel Mount Royal Hotel No Meetings--World War II 20 A&nocialion of American RaHroada Dal*? Chairman Place of Meeting Hotel 1946 1947 19-ls 1949 1950 19.M A. R. Metz Geo.}', Mver> K. K. Dowd R. M. Graham O.JI.Hono!) A. II. Mm? Chicago. III. AllamicCity, N. J. Chicago,III. AllanlicCity, N. J. Biloxi. Mi. ( 'lurago, III. Sherman Hotel Hotel Madison Drake Hotel Haddon Hall Kdgcwater Gulf Hotel Drake Hotel Tut t'n \ii,M \ N Tia Ik \i lli li, (/.-i ll. piogjam is the preseii I at mil ol t)i K< J 0I! <>f t 11;, 11ii;'' i oil D.*.i!.:l;:'- and ](' ii.ihih':il inn. Dr. James K. S:k. a- (;::.. h i: h.i; ( i:ine : v.,!! ;.p ui. t},/ Ri port. Du. Jam i - K > iw k ; ('i... i >mg( oi.. ( l,.i ..go and .Noi ih Western Rail way!: M: fii..ii:i. r and (.< iiilunoi '> fa'.lifih the handling of thi- Jbpoii. v.i. > * miii .ihi.id-. n: d. [,.><.m con-id'i.'ible review and study in j>n paiatiun and winch has nl-o l/cnt distributed to the members in advance tin- r*.-!.mz. I will lead r?*i subject heading.- only, and any comments from tie flour on r .,]i of i- will be most welcome. (Dr. Stack then pn-i tiled the report a* follows.) Hotel i:ion of l K. :-n R.ul- ^ -it thin !i'W ami members ind any Report of Committee on Disability anil Rehabilitation 21 St - (CitcuUr Mo. M 4 S-20U association of American railroads MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION Committee Member* Advisory Member* Hr. Jitiiir* l\. ~> ..-k Oimri, mo. n...-f Hr It. I H.-ii-i.-i .Jr - 1!A. I.i. >urji,wj, ( I 4 N.riti W'-nti. I! J..h-t <. |. I: ,,|w,v. way. hr I! \f. (ii-.li.in, I . .r. I .rr u.i nl ..t Dr. T. f.. II ii.1-1*11. (,'hi.f Surgeon. CIiiobko. nut at i<>n A -Sorjtery. The I'-illti.aii Cotn- thick lullin'! 4 i'.icifio (tintway. Dr. W. W. (.cHke. Cl,,,.-/ ^urgr'ift, llfui..in Ontrtl ^ynicrn. I.t, <\ Cny. f'Vnf ..f Srir/.rv, Chi.-;.*.* U>.-I'i' il. f ilni..i < Vi.rr.il Dr i'. II. Horrall. Chief >i*rvwm. Chiraito. Dr. W. \V. Wiiehbiirn. Chief Surgimi. Uurlirntton 4 Quincy K.nlr.nul. I iloepilai Department, boulhero l`ueilo Dr. ft. St. Keptier. Chief Medical Officer. Company. Chicnao. PurliiiKtiiii 4 Quincy Itailrnnil. Dr. O. B. Zrini-rt. Chief >'urgeon, Minsouri t'aci&e Railroad. Dr A. It, Met* |.-t (.(firm). Chief ,'uf*i-t>n l.itwa linati, CtnraRo. Milwaukee, y*l. Haul 4 Pacific Kailroitil. v 8. Chicago 5, 111., January 26, 19.51. To THI MCUIC.U. AMD ScROfCAL Section: Your Committee on Disability nml Rehabilitation rciixtctfully submits .is its report ft "Digest" of MibjucM by tin1 Cnmnutt'** in past years ami discussed ut various Animal Mi-i-ijin's uf tin- Section. This "Digest" includes a summary of up-to-date recommendations <>r comments uiider e:ich subject ftnd the subjects are listed in alphabetical order. There is also an index at the conclusion of the ``Digest'' which not only lists the name? of the subjects with appropriate cross references but indicates the years in which each subject was previously axi.-idcred by your Committee. .As a matter of re-ord, the original Commim-e was apjroii.led in 1 `.*21 .<s "Committee on Prevention ami Control of Occupational Diseases and I III/aids." Ki'|"'i ts A.-ic pul-Ii-b*-d IK I'.iJ.i tin 1 J !*2-l. In I >2'. - *.. i .i:., r Committee .ipivenrs in *h<i I'rm-i .-liings of the \b->hr;d and Surgi .d .'riioii as the "Committee on Occupational Di-oi.-es and Hazard'." H p"rfs appeared annually from p'2.-, to tQ.'H, mck-.i'.c. fa 1932 the Committee was railed the ''Committee on Occupational 1 h.-eascs and Rehabilitation," and in 1933, this name was changed to the "Committee on Disability and Rehabilitation.'' under which name it Ins confirmed to the present time. No reports wi re made in 1938, 1942-LM4- hi and ItHthoQ. Your present Committee, with the assistance of Advisory Memlxirs as listed above, reviewed the published Proceedings and abstracted the various subjects discussed, as a basis for this "Digest." The Summaries that appear under eaeh subject heading are to be considered as "recommendations to harmonize and coordinate the principles and practices of American railroads with respect to their operation." Respectfully submitted, CoMMfTTse o* Disability and Renabjutation, James K. Stack, M. D., Chairman. -ji; -jrp^gt^i i| nt --"-rr- 'tssb <v* ABRASIONS WITH EMBEDDED CINDERS Abrasion? from cinders cause embedding of colored materials in the skin. The result is u tatoo. All wound? should be carefully cleansed and curetted out to remove these materials. ALCOHOLISM Kerry railroad orrn-iuh.Jh eixoiinters tlx- problem of an employe "ho has rep'ri <<! b>r w oik wild* under lie mllueix-e of 'J'hi' condition ran ii lies! delrinniud In rvidenrr of mental confusion on the part of il,(. individual, ineoordination, and mu K- "dor of aleohol on hi> breath. Further into: mat ion rati b obtaned bv laboratory examinations of the employ! >. untie, breath. and I load fiu alcohol r mt'iit. ALLERGY, HAY FEVER AND ASTHMA lii add11i..n to dlsoi"ions on tin above siihjo.t h-ted in tin index, the C'oiuIiillfee caff- attention I" di'oiis'iof:-- of the Milnerf m the t .'{< {Vocoedfng' by the ('oininii t-e on Medieal A-jx-ot .[ An ( 'ondil lomnir oj ( ars. In rlironie or recurring eases of allergic manifestations, it is imjxirlant to try to dclcrunnr the calls'- of tin- individual's wusitization. The facilities of a sjxTialist in allergic diseases may in- reij'itred in the diagnosis and treatment of such conditions. Tin- newer aiitilu-lainmie drug-. are often of eoiisidr ialife value in treating acute episodes of these condition^, paitirularh it< ha> fever. Kpiucphrin {adrenalin > sulx-utancous|y is frequently the drug of ehoin- in the treatment of seven- aeuti- exacerbations. AMEBIC DYSENTERY In UI3-J amebic dysentery was eoii'idcred by the Committee and discussed following a scattered epidemic, apparently originating in Chicago. Current medical opinion is that chronic amebic dysentery is widespread throughout the United Suites. The Committee recommends study of an em ploye for this disease when prolonged or recurrent enteritis is complained of by him. AMPUTATIONS The end result of aii.juit.iti1 u. at tin various levels i' i.Xtrcnudv ii|>ortant, and furthermore, the duties of tin- amputating surgeon :,re not finished until the amputated extremity has been fitted w it it a satisfactory artificial limb and the patient Ixam successfully rehabilitated. ' Open amputation (Guillotine) is carried out primarily on potentially infected wounds or ujxm individuals who are poor surgical risks. The fact that further revision may be necessary should lx- kept in mind and till possible length main tained. Tin- loo'.| amputation is mu- which is jH'iformed in a clean field nix! in which the skin liaps are closed over tin- end of the stump. The muscle in the amputation serves the function of nclivulion ami padding. Tendons are ordinarily s ctioned near muscle attachments and removed. 1'a-eias in the closed amputations aid in tlx- grouping of muscles around the hmiSb bone stun traction, s at the lev. In the n that is pos too sucresknee joint, should be lower end above tlx- The t<{< ix>i mt (!. The id, :i) . ol elect ioo ; Tlie enntoi: l'o>ll,|,.| and tlien p that the c> minimum >. "1 III- (x-sl prompt urn: limb umi no limb. At U. ize in teachr With the increasing n have s{A-eifi' ing ajj estahl readily deter ism to the vj results an- ti. sensitivity t< nuroenu. T: infection is s; Back Injurie-: A practice spines of ail evidence ofa: The value future compl. One railroa. had made x-ra examination. Itfcx tiotrnJ; Spioa bib Scoliosis Lumbar r the skin. i curetted e who has ,iu.-,cn on on his nations of , the Cnm.odings by taut v itltH-S realm- ... ill t reotillg .piw-phrui -wtment of 1 ihr-'U.'-'^d I'i :tt) <-m.plam<-d of mifHirtant, ushod until 1 limb and lly infected hat further ogth mainnl in which <i padding. removed, trof the ; y 2' j -- ' > v v ' j K S 1 lieport of Committee on Disability nnd Hehabititaiion 23 fx>ne stump. Nerves in oj>cn and dosed amputations arc gently expo-ed by traction, x-vered and allowei to retract. The jx-rinsU-um and bone are divided at the level of final bone length. Tn the metaearpals, metatarsals and phalanges it is recommended (o save all that is possible. In the carpais and tarsal* the amputations as a whole are not too successful. The ideal site of election in the leg is from 5' to 7" below the knee joint. It tin* amputation in the leg is shorter than 4*, then the fibula should bo resected. The ideal stump in the thigh is about 4* proximal to the lower end of the femur. Save all possible linin' in ihe Pamir proximal to l" alwive the lower nul f rite iVimir. The itleal stump m `In- forearm is 'V above t be lower end of the radius. Da not cut the radius and ulna shorter than 1 * distal to the insertion of the biceps. The ideal stump in the arm is 3* above the lower end of the humerus. The area of election m the humerus runs distal Co 4" below the upper end of the humerus. The contour of the shoulder is improved by leaving the humeral head, PnstoperativHy a reasonable jieriod of time .should be allowed for healing, and then physiotherapy should I** administered promptly ami thoroughly so that the contours ln-st adapted to wearing of an artificial limb are secured m a minimum of time. The ><rst fninhoual results an* obtained on those- individuals who have prompt and cllii-ient surgery, adequate physiotherapy, proper fitting of the limb and adequate instructions and follow-up for the most efficient, u.-e of the blub. At tin- present time I here are -ex oral a inputat ion centers whieb -|s-ei.di/c in teaching the amputee to get. flu- maximum use of his artificial meinia-r. ANTIBIOTICS With the discovery and refinement of antibiotic methods and therapy, an increasing number of these are (sang made available for use. Many of lhe>e have specific aflnuties for certain <<rgaiii-.m.-. It i> imp<-r(aut when one ls treat ing :ui established infection that the caus.ttivi- organism lie known if this can breadily determined. It Ls also helpful t>* determine the sensitivity of the organ ism to the vaijou i ant ihe <M<- . Ii ugs. In i i, i> w i v f hcr.apv i-afi - n -cifie and tien-tilts are therefore -no r and recovery v\yn-dn*'d. Tlie ]>atienl may d.-winp 4 sf-ii-itivity to the-e dings lu.mife-ted by euianeoiis and <>fficr .dlergie ;>hcnomenH. The value of :i:iibi<*(ies in the propbvIa< lic treatment of wound infection is still undetermined. Antibiotics should Ih? employed eutiH-rvativi-ly. Back Injuries: BACK CONDITIONS A practice hits been made on a few railroads of making routine x-rays of the spines of ull applicants for employment, particularly those in train service for evidence 0/ anomalies, previous injuries or disease. The value of such examinations is questionable, but may be of value in any future complaints of the employe. One railroad, in addition to mukiug the usual examinations for employment, hod made x-rays of spines of 11 applicants who passed a satisfactory physical examination. X-rays were made in two positions, with following abnormal ities noted: Hpina bifida.......................................................... 235 8coliois.......... 109 Lumbar ribs...................................................... 93 r^e+v^T****** "V/ 1--"*11' 24 Association of American Railroad* Proliferative changes............. ....................... ................... 8acrali2ation ............................ ................ .. ...........-....... Deformity of coccyx............ ........................... ............ Six lumbar vertebrae..... ....................... .......................... Deformity of transverse process______ ____ ____ -....... Incomplete union of 1st and 2d sacral segments_____ Eleven dorsal vertebrae--eleven ribs............................. Four lumbar vertebrae ................................... Thirteen dorsal vertebrae--thirteen rib*....................... Congenital deformity wo-rum...................................... Variation of inlerveitcbral di-c. .. . Cr ivnal rile..................... Congenital defunnitv of lodv of vertebra Incomplete union of Kmum i.o'l i.i t e ul:e ;>'oi e- ! ra< tui 1 lib-.... Tubi:roj!'ei< lung*-.............. FrartUJed jrt-lvi;- .. . . Fjaeturi d vertebra . .Spondylolisthesis...................................................... Tufrtirculo'is veitebiin-........................... Exostosis of rib................ ..................... Calcified ilio-lumbar............ ............................................ 85 61 37 31 17 25 14 9 6 4 3 f> 8 r> ib 12 i JO 3 1 1 2 Total variations........................................................................... 79G Total cases showing variations..... ........................................... 554 Total congenital and developmental........................... 635 Total iiutnlmi of ea.-e.*........ ......... J189 Painful Backs: Painful hacks are frequently complained of bv railway employes nnd alleged to be duo to trivial accident*. There arc* numerous causes for painful backs, some of which are as follows: Prostatitis Chronic appendicitis Gall stones or gall-bladder infections Spastic constipation Congenital defects Arthritic processes Foci of infection Posture Kcnul calculus ItctrojK'rilonen! calcified glandAhdoiuuuil ||nsi-i Mucous colitis Carcinoma of reclnm Pregnancy Fibroses Ovarian cysts Prostate calculi Kenal ptosia Spondylolisthesis Curvature Tumor- of the cold Met a:t at ic tUUmts TmhiiioM.i leiuortIiouIs Neurosis Flat Feet Malingering Etc. Auy employe complaining of back pains which he alleges to be due to some trivial accident should be examined thoroughly with above jioasibk; causes kept in mind. f* i' -S Sacro-ilk The d. majority with late Infect: but the suspicion Spondylo 8pond;. often in associate winch eh the sum: ditton in. compuim trims due Dmgno the onlv An cm; cardio-va.train aervn An emp 200 or dias Employ especially 6houid Ik- Burns aburns, the akin layer: usually is t. open ivour. The ma: lines, that concerned blood and serum chh teied from pressure ii: wound by extent of l i and nuboeq burn cannc excision of patient per sloughing t> considered chemistry n Report of Committee on Disability and Rehabilitation 25 Sacro-iliac Complaints: Tin* diagnosis of -ai'r'i-ihuc ennditmn'* i. iiimh- too lM-<;wntiy. Tlx* great majority of bark ct>nipLiiitt^ given this name arc iti reality lumbosacral lesions with lateral reference of pain. Infections or other inllanimatory conditions can involve the .sicro-tliac joint but the diagnosis of sicro-iliac strain or sprain should be looked upon with suspicion. Spondylolistheses: Spondylolisthesis, or displacement of one vertebra m another, orcur-t moio often in the lundxj.vicral junetioii than in any other region. ft is commonly associated with a congenital defect in the pedicles of the fifth lumbar vertebra, which allows the lamuiai: ami articular facets to remain in normal relation to the sacrum, while the body of tin: fifth vertebra displaces forward. Thus con dition may exist lor years without symptoms and may Ik* very mild and ac companied only by local pain, or it may be extreme and associated with symp toms clue to pressure on the citud.n equina. Diagnosis may be suspected by proper examination of the back, but x-ray is tbe only way of confirming the diagnosis. BLOOD PRESSURE An employe with high blood pressure, if persistent and associated with caniio-vasculur-renal diaeiwi or diabetes, etc., is an unsafe worker und, if in train service, is a menace to other employes unci i he public. An employe m tram xwvj' c du-uid be removed if the ,y>tnlie prcuiv is over 200 or diastolic is over 121). <r if tic he art ape*x is to tin- left of the nipple- line*. Employes whose blood procure is not con.-latent with their weight and age, especially when associated with evidences of curdio-vascular-renal damage, should be kept under observation. BURNS Burns are to i>e looked upon as wounds. In the case of 1st aid 2nd degree burns, the wuur.d is clo>cd and infection will not ja-nctrato iinlc.vi the protected akin layer is broken in the course of treatment. In .'ird degree burns, the wound usually is an op. n on-- and :> to b.- trc-ai' d a uh 'In- -(>.<:t accorded any other open wound. The management of the i-xk-n.-ivc .ird d' grce burn i-, carried out .along two lines, that which concerns the tr<-atm<-nt of the wound itwlfand that a inch is concerned with the systemic abnormalities that follow extensive: burns. Fluid, blood and serum loss is part of the burn pic ture, and ui up-set of the protein, serum chlorides and cither blood const.tuents should be anticipated and coun tered from the beginning. By the use of a mdd c liMiioing agent and massive pressure dressings, infection cun la; held to a minimum and the closure of the wound by a split thickness skin graft should lie done us soon as jjossible, If the extent of the tissue destruction cun be surmised early, then exci-ion of this area and subsequent grafting will hasten the healing process. If the extent of the bum cannot be determined, a line of demarcation muy be waited for and then excision of the necrotic skin carried out. When the general condition of the patient permits, curly excision ia preferable to wuiting for the established sloughing to occur. Plastic procedures for the relief of burn contractures are considered only after primary healing has tuken place and the patient's chemistry is in good balance. >k foilfa 26 Ajuociatton of American- Railroads CARDIO-VASCULAR-RENAL DISEASE A pc-reon with cardio-vaseular-remd disease should have a careful exami nation. This examination includes the heart, blood pressure, urine, blood chemistry, and n check on the clinical symptoms. The eyes, including the eye ground' and vision should Ik- noted. Dizzy s{k-ILs, angina, edema, and dyspnoea should Ik- carefully evaluated. The conditions of the heart muscle and coronary vessels should lie determined. Repeated examination every six months or oftener is important. J-.'mpl'ives in train, engiw. yard, mu! -ign:J service with advanced aortic h*sion>. definiti myorurditi-, In-art bl--<k, aneurysm, and angina jx-rtoris and auricular flti<<u- -Imuid he n-inuvi-d (non "-rviii . I'i tmois with auricular fibriilaljnii' linvi- a high in* -/1 a 111 v rale. ((n-hral and odii-i cnniplic.-it inns frequently occui. An employe with <-:<n-< lif-uw. An-nM h> niin-vi-il from service until he pre'enis >at i>i.n nay c\ i<)ene( >.( n > <vi :y w nh"in re-id uni damage. CATARACT A catainet in one <>< ieduce- or destroys the vision m that eye. After ojK-rafion on one eye the refraction of the two eyes is different, which causes defective vision and judgment of distance is poor, i'ost-ojierativf vision, corrected or uncorrectcd, i> exceedingly }gor and judgment of distance is impaired. Engine and train service men with cataract, whether oja-rated on or not, should lie limited t<> services which they can jx-rfonn safely and satisfactorily. This applies ul-o to engine and train service men with bilateral cataracts, whether ojierated on or not. CHARCOAL HEATERS IN REFRIGERATOR CARS One hazard involved in the use- of charcoal heaters in refrigerator cars is the formation of carbon monoxide ga','which if inhaled in sufficient quantities causes unconsciousnc.--. and sometimes death. With ordinary precaution, however, this hazard is found to !* slight. In addition, it is found that the carbon monoxide gas drvolojx-d is toncficinl to commodit ies shipped, apparent ly destroying bacteria and inserts in the fruits and vegetables, and retarding decay. Instructions are issued by all companies u-ing charcmil heaters, anil it is found that the employe* handling these healer' mhiii beeimu- just a> conversant with the iiisdui tion- eoi.ei riiiiig handhng the-e h' ntei- as ihey are With coma otional tram and operating rules. Tfie National I'ertsliabh- Freight Committee told West Jackson Roulvvard, Chicago G, Illinois), has issued a circular on this subject (Circular No. 20-C, September, 1948, and Supplement No. 3 to Circular No. 20-C, December, 1948), and these rules, with some modifications, are. still in use. lo addition to the general instructions, placards are attached to each side of cars furnished with heaters, reading as follows: WAKMNG FOISON'OUS FUMES Heated Car (etc.) tre art arn. shc J dis. di.'< jm, T othan f T pro fit .V view mcb. in th can b be p< barm lower Sin of Col I)is A t< out as or any lanter: plate) There the pr; Coiib'lok. Refer Medicii. on "Son (J.A.M. present in 1950. Infectio; Report nj Committee on Disability ami Rehabilitation 27 CHRONIC ARTHRITIS Chronic arthritis may be divided into rheumatoid arthritis and hyper trophic arthritis. In rheumatoid arthritis (vhrtmic inlVrttous arthritis, atrophic arthritis and arthritis defonnan.-O the etiology is -u.~peeted as being inferUmi*. The knees and tinkers are chielly .fleeted, although the shoulder to elbow, n ri't - aid .'pine. may be dinted about from Hypertrophic ... fliriti.- idegenerative arthritis, ite<>:irthiitis) is usually a disease ot jJCople ju.-t huddle -n't;. Obe-my <>r over-weight may aggravate the disease. In this eundilnm there is a d`hmte ar'ilaginuu.s destruction in the joint and the cartilage is worn away and the underlying iKme is exposed. These two types of arthritis cannot definitely lx* wholly divided one from tlic other. Clout aL-o slmuld lx- considered in the diagnosis und treatment of arthritis. Treatment: salicylates are by far the most useful drug in most coses up to the present time, but as a rale this relief is temporary. In early cases it is sug gested that a focus of infection be identified. ACTH has been introduced for the treatment of rheumatoid arthritis. Io view of the fact that adrenal cortical stimulation affects so many important metabolic and phy-iologio processes in the body, great care should be exercised in the therapy. At the present time the immediate results of ACTFI therapy can Ilost be explained as dr.un.itie. Only time will (ell if these eonditiotts may bo permanently benefited. ACTU therapy ran do gi.*l but it may xbo to harmful. Kurly aeute >-.ws <f rheumatoid arthritis do totter in general on a lower dose than is the case ot longstanding more severe disease. Similar dramatic improvement hits been observed with the administrirtioo of cortisone acetate. Disabilities from arthritic frequently are iniprojjcrlv attributed to injury. COLOR VISION A test for the .l- o - tion of color >lcfe-?< demld be one which can be e.irri-d out us rapidly ;w p v-ibte with maximum eilinem-v. The Holmgren wor-ied, or any standard modification have historically been very reliable. Several lantern tests have Ix-en devised which are also reliable. The (sitiiura {color plate) test, which was modeled after the Stillings test, is rather accurate. There are several modification?. of this test but the colors are apt to vary with the printing of the color plates. Color plate tests are favored; lantern tests also are reliable. Field teste are not reliable and therefore are not recommended. THB "COMMON COLD" AND UPPER RESPIRATORY TRACT INFECTIONS Reference is made to address of the Chairman of the Section on Internal Medicine of the American Medical .Association at their convention m June 1950 on "Some Problems of the Common Cold," together with his list of references (J.A.M.A. 144; 287 Sept. 23, 1950). This is a rather complete nummary of present concepts as to etiology, treatment and prophylaxis of the common cold in 1950. Also, attention is called to discussion by H. A. Iteimana on "Viral Infections of the Respiratory Tract" (J.A.M.A. 132; 487 Nov. 2, 1946). .Laf.'mW.. ,JrtJ Si$j*TxlVp*a^-if, 28 Arsoctafton 0/ American Railroads The Committee agrees that vaccines and vitamins are of little value in the prophylaxis and treatment of colds; that sterilization of the air in occupied quarters by ultra-violet light irradiation, or by aerosols, such as the glycols, is of little proven benefit in controlling the spread of the infection; and that while the use of antihistaminic drugs may be of considerable value in allergic types of rhinitis, they are of little value in virus typo infections. Attention is called to possible reactions from use of antihistaminic drugs, and it is recommended that these drug* should not he used during work by engine men, or in other occupations where jsior coordination or drowsiness might prove to be disastrous. Hygienic habits are advocated a* a prophylact n- me:u*uiv. and medical carei* advi'ed 1! the afTc. ted individual is doti-o'd "t h:v a fever. Caution in the early alagi*> of a "ruld" is advocated, to protect other contacts and to avoid scram* coniplicatem?, such u* ptwunimiu. CROSS EYE -STRABISMUS .StinhiviiiU- usually is H.-.-neintcd with partial 1<>-- of vi-um io one of the eyes, 01 tin ;i- is un aitcrnatnig ti.ioo fn.i,. one (> t<- the othi i. A |x-tson so afflicted is in the >mne enlegorv a*- the noe-ovrd fx-rson. Then* is 11 lack of luUM-le balance and depth jxTn-pi urn. Engineers and firctuen t>o afflicted should he hunted to serein- which they cun perform safely and satisfactorily. DERMATITIS Gloves which will absorb cre-osoU- should not be worn in handling of creo- soted timliors, because they ure likely to Ix-comc impregnated witli creosote and increase the severity of exjxwure. In the prevention of oil dematitis the Committee recommends the use* of suitable clean clothing, the protection of exposed skin with protective creams, and thorough cleaning of skin after work. It is advised that certain workers who may be found to have a marked sensitivity to a material used may require transfer to other types of work not involving occupational exposure to the accused irritants. See "Poison Ivy and Poison Oak." t DIABETES ll i- ;:giceil that no diabetic taking insulin should b<- allowed to continue in any hazardous occupation connected with train service, when* a sudden in capacity would jeopardize cither his own life or the live- of other*. Any diabetic taking ii.Milm is js.tciitially u dangerous mat*. Diabetic individuals ure more subject to degenerative eye changes than normal individuals, und it is recommended that eye examinations to include fundus findings by a specialist be carried out at fairly frequent intervals, especially where routine eye examinations show failing vision. Attention is called to possible complications from injuries, especially to the lower extremities, from pre-existing diabetes, and the Committee recommends particular attention to the cam uud protection of lower c.xtn'inilwH of diabetics. Attention is ulao called to the association of diabetic disease with cardio vascular degenerative diseases, and occasionally with coronary artery disease. :Yg: . "d- V - Itisemphae: are dangerous. acting insulin c It ia agreed t by a satirf&ctc lions, but that tion with train dinU-tic condit that periodic eease is maintm Further con in.-uht; treutm* DINING C In 1934 foilpun-iitly origin purl of railroad to be printed 01 curs and dining Comment--> do not conform pretirriUxJ Jy ti Chief Surgeo Regulations (Id U.S. Public Hey issue in the near road servicing p Sanitation Man The problems along with othm actively progro Joint Comnutu medical mcmlK*; liaison group wit sideration of pr< cedurcs. Since World V services in man> rant workers, i participated in 1 There are prm 1. Heat c holism, px>; di**(x>M<` t<> h cienl table : the amount -L-3.r " - c value in the ir in occupied the glycols, 'inn; and that !ue in allergic .imiiuc drugs, .ring work by u drowsiness : medical cure .mtion in tin; and to avoid ie of the eyes, .V person so is n ' `c-k of l.illg t.t iTCO* -all .'vi>iMite Is the w-c of tive creamy, ul.i-d I a.ak not i I'mmuc in sudden iuhers. Any .uigvs than . to include t intervals. -ally to the .commends 1 diabetics, itb cardioryd' ae. m Report oj Committee on Disability and Rehabilitation 29 It is emphasized that occasional injections of nwiim, ;is once or twice a week, are dangerous, unless patient is hospitalized; also, that newer forma of slower acting insulin do not free patient from the dangers of reaction. It is agreed that an employe with mild diabetes which is properly controlled by & satisfactory diet may be permitted to continue work in certain occupa tions, but that an employe in a hazardous occupation, particularly in connec tion witli train .service, should be removed from such an occupation until the diabetic condition is brought under gwd control without the use of insulin, and tli.it periodic examinations are indicated to see that proper control of the dis ease is maintained. further conclusion--Any moderately severe diabetic, whether receiving itisuhu treatment or not, should be restricted. DINING CAR EMPLOYE INSTRUCTIONS; FOOD HANDLERS In 1934 following a scattered national epidemic of urncbic dysentery, ap parently originating in Chicago in 1933, the importance of good hygiene on the part of railroad food handlers was re-emphasized and a list of recommendations to lie printed on a placard and posted under gloss in kitchens of railroad dining cars and dining rooms was presented. Comment--rfovoral of the instructions recommended in 1934 are sound but do not conform to recent codes of pntctiii: relating to eating establishments jircscnlyil by the Public Health Service. Chief Surgeons arc referred to recently amended Interstate Quarantine Hegui.ii inns I P.'Oy and to I he Salutation Manual for Interstate Carriers of the U.S. I'iiblie Health S-rvice 11UI2). The Public Health Service is contemplating issue in the near future of several manuals relating to dining car practices, rail road servicing practices, etc., and it is contemplated that these will replace the Sanitation Manual of 1942. The problems ot dining ears, food h milling, and eating and cooking utensils, along with other problems with relation to sanitary procedures, are now lining .c tivelv jr<igr<--.*ed by the IV-h-r d and State I'ublie Health agencies. The Joint ('onumUve mi H.tih'.ay S violation of the A.A.It., on winch are three medical members representing the Medical and Surgical Section, -erven as one liaison gr nip with repr< -mitai ices of the l.'.S. I'ublie Health Service m the con sideration of problems of and practices recommended for railroad sanitary pro cedures. Since World War 11 the L'.S. I'ublie Health Service and state and local health services in many cities have been carrying on schools of instruction for restau rant workers. In many places the railroads have been invited to and have participated in these schools. Officers of dining cor departments are advised by the health authorities of such meetings. DISEASES DUE TO HEAT There ore primarily three diseases due to heat. They are as follows: I. Heat cramps--primarily duo to loss of salt. Orgaaio dweaeea, &Io holism, poor hygiene, fatigue, malnutrition, generally poor health, aU pre dispose to heat cramps. Heat cramps may be eliminated by taking suffi cient table salt and water, depending upon the humidity of the day and the amount of sweat lose. i 20 Association o} American Railroads 2. Heat exhaustion i. primarily due to poor dietary habits. It is pre i cipitated by improper clothing, the ingestion of too much or too little food, and poor hygiene. Prolonged physical exertion in a bot environment may aggravate this syndrome if proper food, sleep, hygiene and baths are not > bandied intelligently. 3. Heat stroke (heat retention, sunstroke), is due to the gradual ele vation of body temperature over a period of hours or days due to the hot i environment, improper clothing and improper diet. This condition may i be aggravated by poor body cleanliness and hygiene. The nmst important point m the treatment of thi.- corn!it ion is t<* pack the patient in ice until the tcnijsTaiu:'- gradually descends to SO:)-104' )'. Intravenous fluids may than be blurted and the ice therapy gradually pusjiended. ELECTRICAL ACCIDENTS The ev-i'iitmLv of tu ntim nl of cl> rtnral iii-i idcMs arc: 1. K< the elcct.' jii-,i jx /m.ii from the ruricnt in tin- quickest and safest jmssibSe way. 2. institute artificial respiration immediately if \ ictini is not breathing and continue nrtilni.d p-spiralimi preferably by tin* .SchuefTor prom* pressure method, until there are unmistakable signs of deulh. 3. Victims of electrical accidents in the vicinity of large cities may re ceive rapid emergency treatment from the inhulutoi squad maintained by most modern l'oliee Departments. EPILEPSY AND EPILEPTIC EQUIVALENTS The subject of epik*|K>y and epileptic equivalents is one of great importance in railroad medicine, and the dangers of such a condition cannot be too strongly impressed upon the Chief Surgeons of memlwr Lines. It is desired to emphasize that all epileptic seizures, whether of the Jacksonian or any other type, should be eau.se for permanent removal from any hazardous service connected with railroad ojwrations. It is not eawmtial that a "Grand Mai" should la* exhibited, as any case showing a "Petit Mai'' is just as important both to the employe and the employer when exhibited by* any person engaged in engine or train service or other hazardous occupations. As previously stated, the epileptic equivalents present a far more difficult problem than actual epileptic seizures since attacks may not be accompanied by convulsions, and the entire manifestation, may consist merely of a momen tary loss or Isijwe of euiiM ioustio.s... louring such a brief slate, serious accidents could be caused by employes engaged m engine or tram service, which give* the subject a momentous importance from the Railroad's standpoint. It is recommended that all eases of disruption of the mental faculties, even though momentary, should be carefully investigated before {*rmitting the employe to return to duty in any hazardous occupation. Any recurrence should be considered sufficient to warrant the affectum as being chased of a disqualifying nature and such employes should be prohibited from engaging in any train or engine work, or other hazardous occupation. First injured ; Emerge Aid are p&mphh who arc "Teel I T)i<- mii: In a le-.-. iml l- ii When- wilhont offender Period the. imp: am<mg r: As jam term is o Among the patiei as the ca chemicalcelluixHiu due to v distingub of food p< "Ptom Acute eating La jwnied b; (whvatioi coccus to or before ing is cm short iy a bm-ff-r have a n seen in st Reference 1 Food * Epidc Rcuuaiiti * Ptom (Apr.) JS ft is pre~ little food, ^ment may ha are not '.ujiiil e)e- v the hot idem may important <11 iff UlltjJ liguia may lickeat and : bre ffcr r ls may re clamed by niporl.mce .-tr>ngly .,f *.f the ,.,v.d li'>m . , ,:vl Ml Md'' is l.-.t by any .tloOS. re difficult ''vnipvjufid inonien- s wctdcnu huh give* t. iftiea, even lining the recu/reoce lapsed of e > engaging I L Report of Committee on Disability and Rehabilitation 31 FIRST AID AND EMERGENCY TREATMENT I-'irst Aid should lie considered us that treatment which is given to a sick or injured person by laymen. The services of a Physinan .should be referred to as Emergency Treatment and not as First Aid. The essential principles of First Aid are already published in a pamphlet endorsed by this Sort ion. Such a pamphlet -bouhl lx* available to every r;ulr<:ul employ**, particularly those who are ciig-tged in work >>{ a hazardous nature. FOCI OF INFECTION Teeth, tonsils, prostate and -nm-e> d'e the most. ifn(>ort.iiit foci of inf****tion. The middle ear, gallbladder, .-ipiK-ndiv. urinary bladder and colon art* offenders to a lower degn*e. Carious teeth, pyorrhea and other gtini infectious -dtmdd not. lx* overlooked. Whenever injury >>r pum is complained of m the lumbar or sacral regions without objective findings, (he prostate should be considered as a /xjssible offender rather than trauma. Periodic physical examinations with attention to focal infection will aid in the improvement >f general healtli and increased work capacity ami efficiency among railroad workers. FOOD POISONING As pointed out by (j. M. Hack in his monograph' on "Food Poisoning," tlift term is of necessity vugtje. Among the common causes of gustnv-intestmal ujwets fretj rifn fly related by the patient n.s coming from their food or drink, and sometimes by their doctor, as the cause of their gastro-intestimd upset, are bacteria and their products, chemicsU, jxiisotioiis plants and annuals, prob^tai and lieluiintli.s, and a misc<*llaneoiis gnu ip of dtiicva--, (llr ,;*> ,s .,f w hich arc unknown, but quite likely due to vims infections, and commonly known a* "uitc-tinal tin.*'* Osier distinguished between the endogenous and the more common exogenous yourian of food poisons. `'1`tomame }ni*'*nii>g," according I * o k and ofhefs is a misnomer.* Acritc gustm-enteritis coming >m -uddenk w iihui >ne or sever d hours after eating fainted food, md wi'h vmj.ioin- *! .inu,g -j-i.-nty. u.-u.dly uceotnpafued by abdominal i-ramps and diarrhea, nni occasionally by vomiting, salivation, ami severe slioek may freipjrntly be shown to Is; dun to staphylo coccus toxin, that has been built up m the fu*l during tlit* preparation period or before, sometimes from improper handling or storage. This type of poison ing is commonly found where the complaint arises in a number of individuals shortly after partaking of jrortions of the name questinruihit? fond. Hacferiid infeetions, sijeli as Salmonella. Shigella, streptococcus and typhoid lutvc a more prolonged incubation jv-riod m the Ishly than the short perns! seen in staphylococcus toxin cnu-ntis. Reference* 1 Food Poisoning, G. M. Duck, Univ. of Chicago Press Publ. 1943. * Epidemic Diarrhea, Nausea and Vomiting of Unknown Cause. H. A. Reimann, et al. JAMA 127-.1 (Jan. 6) 19-15. * Ptomaine Poisoning u Myth. G. M. Duck, Indus. Med. A Surg. 18:151 (Apr.) 1949. Jt'v :. --*-* T'J ~ *V ?*> 32 Astocialion of American Railroad* Water from a certified domestic source is rarely the cause of an acute gastro intestinal upset, such as is sees in staphylococcus food poisoning or in "intestinal flu." GLASSES AND GOGGLES All tinted or colored lenses now available for glasses or goggles are colored filters. Most colored filters reduce traasmission of certain portions of the visible njieelrum and impair color vision seriously. Colored protective lenses for glasses or goggles must not lx* used by em ployes involved in the operation of trams, where duties require accurate in terpretation of color signal'. It is liojx-ij that an ideal absoipuve glass for use as a protect am against glare will soon be available. It will be a neutral gray, transmitting aliout thirty |/ m iit of all viable light ami afT'-rding almut equal visualization of all the colors in the spi ctium. Such lenses must be ia'gi ami immured m aviator's tvjv frame in order to C(Aer the entire vi-ual h-iti. H tin imlmdua] requites refractive correction, his leiists should be gnmi.d re lie prc-eMption. (.'liji-ni, lenses o\er regular glasses arc. not permitted. I'mler no circumstance- should these neutral gray lease-, or any tint'd or colored lense worn at dawn, du*h, on cloudy days, or at night. They should lie worn only in sunlight. It is recommended Unit glaswa or goggles worn by employes using hand tools, or operating power machines, etc., in shops, be made of shatter-proof glass. HANSEN'S DISEASE (LEPROSY) Transportation by Common Carriers of Persons Afflicted by or under Treatment for Hansen's Disease Attention is railed to the action by the Committee of Direction on this sub ject as reported in the Proceedings for 1917 fpps. 17-20), and discussion of the same subject in Proceedings for MHS fpps. 71-741. Nothing further has developed since those reports to indicate a change in the recommendations of the Committee of Direction, Medical and Surgical Sec tion, to the Association on,this subject. It is recognized that while leprosy is considered to be u communicable disease, such communicability is of very low grade ami not |jos.'ib!e from contacts as exjxricnced in travel of such ease.- on railroads. The di-ease i* not listed among ``Communicable Diseases'1 in the 1917 Federal Interstate (Quarantine Regu lations, nor in amendment* then-re of !9n<). While it apjieai-.- that active, uncontrolled eases of the drease sIk-ukI be restricted in then activity for the pence of mind of uninformed contacts, treated cases in controlled stages of the disease present no hazard from contact, and should be jiermitted tu truvel within the limits prescribed and permitted hv public health authorities. HEAD INJURIES After a blow on the head, the imjiortant thing to determine is not whether the skull wn* Inn-lured but rather the extent of the injury, if any. l< the brain or its vessel.-, l b* patient with a head mjuiy should not lie subjected to the movements necessary to get x-rays of the skull until it has been determined that such manipulation is safe. If the x-ruys can be made without manipulat- ga.stror ir in v ..i{<>rcd tto of I I'C ,1 liv -mi-nr itn in* aw.-t glare .nut thirty uf all the m order to correction* ver regular y t. or hey -d -hand tools, .1' glass. W: 9 r1 r. .a tlm .-ub -ion of 'he it.40 hi 'ho ti-i5i--.il .-V'- ,silt; disease, rant acts as led among title Hcgu<hat active, , tty far the ,igcs of the 4 to travel Vies. at whether y the bruin cted ` the let "* 'nanif Rrjkirl <1f Ciwiinillrr on fji.mhtfi/i/ anti Uvltnlnhiulion 44 ing the head, they will supply additional information. The two intracranial lesions that are moat important to watch for, are bleeding from the middle meningeal artery and the development of subdural hemat-oma. The more severe lesions of the brain structures pmjier are not amenable to surgical treat ment. The patient who has i>eon rendered unconscious by u blow on the head should lie w.'itefnal carefully, particularly his hlmid pressure, reflexes, pul-e, tyjie of respiration ami pupillary reactions, and general tone of the muscles of the arms and legs. Tim so-<alld "lucid interval" so long associated with middle meningeal In-morrhuge, should not be depended upon entirely. A jierson may lie rendered unconscious by concussion of the brain and by bleeding con comitantly from a ruptured middle meningeal artery. The pressure exerted by the hemorrhage will be enough to keep him unconscious so that the pupillary signs, pulse and blood pressure are the beat indications of this. The subdural hemorrhage and its symptoms may be delayed. The neck should not be neg lected in people with head injuries as frequently the violence of such injuries to the head could subject the neck to "whip-laali" meolmmxfn. HEARING DEFECTS AND TESTS Candidates for employment in train service should not lie accepted unless able to hear ordinary conversation with each ear separately, the full distance of 20 feet. No candidate for promotion or re-examination can be considered to have sufficient acuteness of hearing, who is unable to hear words or numbers spoken in an ordinary conversational tone of voice, at a distance of 10 feet with each ear separately. The use of hearing aids by railroad employes engaged m train nervier is not rceonnornded. HERNIA Hernia is in. i.lriil to anil not an accident in industrial occupation. True traumatic hernia is so rare as U> lift almost nonexistent. Inguinal hernia is a defect due to a <ongemlal, amitoniir.il disorder, or to developmental weakness, or to both. Wither single nor rrqx-ated exertions or injuries cause inguinal hernia. The problem of aggravation of hernia will seldom be raised if pre-employment and periodical examinations are required. The presence of an inguinal or femoral hernia should disqualify applicants for train service or laborious work. .Small asymptomatic umbilical hernia is not disqualifying. Knlarged inguinal rings in the presence of a demonstrable sac or bulging should lie grounds for disqualification in the pre-employment examination. On re-examination, the presence of an inguinal hernia should be noted and treatment advised if it is complete or producing symptoms. Such employes should l>e operated upon if their general condition permits; otherwise a properly fitted truss may be advised. The development of a hernia suggests the Reed for a thorough physical survey with particular attention to the in dividual's gastro-intestinal and urinary tract functions. The injection treat ment of hernia is not recommended. INJURED EMPLOYE In connection with this subject heading the following is quoted, simply as a matter of information, from the "Rules Governing Monthly Reports of Rail- j 34 A*octolton of American Railroadt way Accidents" as issued by tbe Interstate Commerce Commission (effective on January 1, 1922): "Accidents to be Reported.--A reportable accident is an accident ariaing from the operation of a railway that result* in one or more of the follow ing circumstances: "(a)**** "(b)**** "(c) Injury U> an employee sufficient to incapacitate him from perform ing ids ordinary duties for more than three days in the aggregate during the 10 days immediately following the accident. This rule itppln - to employee* on duty, ml to those classed il- not on duty, but (Jo<- not njijily to t uijiloyeo classed a.-1 passengers or tres passers "td> Injury to a i>on oil.it tlui.'i no employee if tlu* injury is suf ficient. in tin opinion ot the reporting officer, to incapacitate the injured jx-r.-on from JoiJowmg hi.- customary vocation or mode of lib for a ja-riod of more than one day. This rule applie.H also to employee.- d.i.s-ed as p.i-seiigcm <u treaj>aaser>>." MALARIA T he problem of malaria m railroad employe- doe* not up(ieai w> wriuw or prevalent in ldod, due to the use of newer insecticides and methods of control and newer drugs for treatment. Employes who have contracted malaria should be under treatment and observation until there is reasonable assurance that no further attack* of malarial cl,ill* will occur. MAN-FAILURE After investigation it has been found that u very large percentage of train accidents was due to man-failure. For the above reason the following recommendation, which was originated by the Committee on Disability and Rehabilitation and approved by the Association of American Railroads, was made: "Whenever investigation of any truin or train service accident indicates man-failure as a causative factor--such as disregard of signal indication, disregard of or misinterpretation of train orders or rule*--tuid miggi^ta an impaired physical condition ns u eontnbiiliny cause of the failure, a medi cal examination din cu-d by the O-ompany of the employee or employees so involved j recommended." Ollier recommendations made: (1) IVrioihc exammrif ions of tiio-e wliu.v nge or previous condition would illdii'..)c tli.'d the-- CMilnili.i 11 ill- should be made. (2> Ib-exiiiiui.i.tn-n uj every empi-ye m the train and engine service when he ha- bee n absent bum work for any length of time and cause whatsoever. MENTAL AND NERVOUS DISORDERS No mental syndrome is caused directly by railroad work. Disorder* of the central nervous system are: I'.-yclmse* Paresis Paranoia 11 (effective advnt aris: I Ik: irilloW- ... ('ri furjii- Tiurt rule i on duty, 'tra or trea tin' (H <uf.VUlUtC til ur mode of lied also to srio^ .r f.f control l.iria ahouW tee that no -t ir on , originated l by the it indicates iiiiltiMltgn, uggcaU an iv, a modi'.inployeea tloQ WOuId rvice when oever. I i >II Report of Committee on Disability an4 Rehabilitation 35 Minor functional nervous states Epilepsies and epileptic equivalents Organic neurological disco/sea Inflammatory iIlsooso of the brain and nervous xystem Paralysis ngitans Choreas--all forms Cerebral ar'eri>><elerosis Other 'rgame wuroiogical ituidiTioiia Traumatic psychoses and neuro>es Constitutional psychopathic, state Chronic alcoholism nnd drug addiction All other diseases of the brain and nervous system Employment of a veteran of military service having a discharge account of being a mental or psychiatric rase should la- (>*tpnncd until a transcript of the medical history is secured in writing. Employes with any mental disorder should not be permitted to remain in positions of responsibility, or where they may become hazardous to themselves or others. This ereo after apparent recovery. The following should be disqualifying for any employe who has to do with the operation of trains: Disorientation for time or place or persona, continued Intense narcissism or phobias Memory loss for recent events, prolonged and continuous Ideas of reference Fixed or repeated transient systematized delusions Catatonic states Paranoiac ideas 1.osa of insight nnd/or judgment, gradual Moderately severe inability to adjust to reality Klin.t (Kludl-lll, V.Tc, /'pouted Chronic alcoholism or other in toxicalinns with mental deterioration Industrial and familial inadaptability duo to any of the above con ditions nnd ideas Defects of personality--progressive Paralyses and/or paraplegia Marked euphoria and/or delusion of grandeur Wanton violence and destructiveness Tremulous, stammering, dysarthric, slobbery speech with loss of musculocutaneous sense Moderately severe neurasthenia or hysteria, or anxiety or psychasthenia or hypochondria, which has not responded to one year's treatment Epilepsy and epileptio equivalents Hemiplegia, paraplegia and locomotor ataxia with mild residuals AH inflammatory diseases of brain and nervous systems with mild residuals Paralysis sgitaos with beginning pill roller's tremor, mask facies with or without beginning mental changes Choreiform syndrome any type, moderately severe, with or without peychio phenomena 36 A**ocuition o) American Railroadt i Tic douloureux Jf persisting over six months and shown not to be amenable to treatment Flaccid paralyses due to peripheral nerve disease or injury, affecting at i t least one Limb Cretinism, imbecility and middle class moronism Migraine with no remission or short remission which have not responded to treatment for a year Demim's disease Bruin tumor Syringomyelia Subaru!' ' >1 degeneration spina! eord Amvot jopiiii- |<V n'TJii ion spurn) cord Multiple m l< ro-.c Spinal <-oru tun--.' Residual- of -knl' ba<lure Hernia I <! inn-i v bra] di*'- w it l< di-ablmg sign.- Once an empr-vt i- de i for service it, the o|>er;tti<iri of trains due to his having developed nv mental condition, said disqualification should be made permanent. No employe who ha*. I*een confined to n mental Institution by court order should be permitted t< return to any tvj>e of work until he has received his writ of adjudication. I 'util this is received he is a legal incompetent, NARCOTIC HABITUES Narcotic habitues re mil suitable for railroad service. On both pre-employ ment and jicriodic physical examinations the examining doctor should be par ticularly careful to observ multiple wars of hypodermic injections throughout the body surfaces. It is most common on the arms and thighs. Moat of these habitues over a pcriixl of yenra become mentally retarded, unstable, unreliable, and most of them acquire n method of obtaining funds to buy narcotics other than their normal income. The. reason for stealing to obtain money to buy narcotics is due to the hod that they must take larger and larger doses of nar cotics to get the same "lmg" from the drug. It finally comes to the point where they arc taking huge doses to get the same reaction that previously they obi nined from taking n mum Her dose. As Heroin and other narcotira cost about $60.00 an oum-e and nddiel* honiciitnc.x use this amount in one day, this is the reason why e\ir;i moo. \ imist'lie obtained to buy drugs. Then- an- several in. t h.'ds of rip ing these individual.- of their drug habit jo both private and -tai sod federal ue fitiiti<i>, but it i> known that many of these individual- take the ``eure"niily to la- able to start on smaller doses again to get the same "liung " If n habitue really want' to get out of tins habit arid really means it he lake- the cure `Void turkey." This treatment consists of locking himself in a room, throwing the key out the window, and actually going through the tortures of terrific muscle spasms and vomiting until he is relieved. When the "cure" is taken this way lew return to the habit. NEISSERJAN INFECTION (GONORRHEA) The use of sulfa drug* m jrph\ lax is and treatment Las largely given way to antibiotics, the most common of which seems to be penicillin. Diagnosis should hr definitely established, if possible, by microscopic examination and culture. jL c a W 8f CO Of. Wl w< 1], co sh* ex: fur. ner I as i. plo; iobl. o be St Report of Committee on UioalilUy and Rehal/ilitalion 37 Oi- The patieat should be observed periodically, at short intervals for the first two weeks, and several times during the next three months to confirm cure and to pick up possible complicating infections. i.led e to ! be der his, OBESITY Individuals who ore overweight are putting :ui extra amount of work on their important body functions which especially involve the heart and circulatory system with a tendency to iniTfei.se blond procure and extra work on liver and kidneys. When exclusive weight is carried over a iwrind of years, the ulmve organs tend to Income exhausted prematurely which diminishes the individ uals' efficiency in carrying on their work. The problem of olwxily is Ijoh managed by advising jtooplo early in life :lh to what their normal weight should lx* and for them to regulate their diet so as to j keep their weight within the normal variations. It is dangerous to attempt, to control weight by the use of drugs unlo* under competent and medical sufwr- I vision. A Time Table for Reducing and Regulating Weight was adopted by the 5t Section in 1935, which, if observed, serves as a good guide. All roads are wel come to use it. It is recommended that a man who permits his weight to exceed by 50% average normal weights should be restricted from duty. No one ever got fat from eating too little. iarout mse hie, her <uy ar>int Kv <it 'he im of un ,nd of m* ed. to do ONE EYE Binocular vision is essential in those persons who have to judge distances. When a person has only one eye. depth perception is destroyed and the per spective becomes erroneous, and causes a hazard. Engineers with one-eye potential should Ixi limited to services which they can perform safely and -ufi>>fa<:torify. PERIPHERAL NERVES Incomplete and r oioplcf.o .-onions of [m-i tplu rd norv>--. >ivould lx- repaired only under ideal conditions. When the Aonud is rlt-:m and tin pa)u nt ts seen within nix hour period, repair can lie attempted a.s a ho-pital procedure. If the wound is st all questionable because of contamination or possible sloughing of f the skin, the nerve repair should Is* fioxtponod and done :ts a wmndary pro cedure under ideal circumstance*!. The diagnosis of jwripheral nerve injury should be made pre-o|X*ratively. The possibility should lie in the mind of the examiner ns .soon ns he notices the site of the wound. Ail motor and sensory functions of the nerve distal to the wound are carefully examined. In this way, nerve injuries associated with the other tissue injuries will not be missed. PHYSICAL MEDICINE Physical medicine cofmu>Ui of physical agents which arc considered invaluable as an aid, not only in the treatment but also in the diagnosis of injured em ployes. This value is directly proportional to the earliest ponatble time it is instituted in the therapeutic program. Tiin* 38 Atsocialirm of American Radroodt Heat, massage, and exercise are the procedures moet easily obtained and the simplest to administer. The early application of elastic bandages for crushed extremities has been found to cut down the period of convalescence and to diminish the percentage of probable disability. These agents are also moet valuable in overcoming circulatory disturbances and maintaining and develop ing function. Heat may be given in the form of hot baths, hot dressings, or dry heat as may be indicated. The value of hot wafer treatment in any form lies in the fact that it is a form of mm-t heat and the chemical content of the water l- immaterial. One form of wet heat, the arm or leg whirlpool, combines motion with heat and is valuable in the treatment of extremities. Mas-age along with mot ion in the early stages of injury is particularly useful. The usefulm s-deja-nds <>ti tin intelligent ehmee of the following: 1 i .sujx rfieial stroking; 2'deep stroking '}> kneading: 4> friction. Each particular maneu ver is used for a -|.'ial pi.rpo-e. I'.'xerei-e consist- ot alternate emit.irlimi- ami relaxation of group-. Active excrn-c is the mdv measure that is known that will increase muscle streiig! 11. Passive e.vrm-i- i- u-cd u hen healing is not complete and a rung* of motion instituted so as to pn-vent Hiikly<si-. Forced motion is principally Used to hreak up joint adhesions. The term "tiicru|>euhe exercise" is given to thone exercise* Used on ex tremities whose reflex nerve arc is intact. "Mu-ele rendmat ion" i- that term given to those exercises used on ex tremities where the reflex nerve are i- impaired or broken. Occupational therapy is of proven vnhu by prescribing various tyj* of work for bringing into use muscles and joints which need exercise or rehabilitation. One of the best forms of occupational therapy is the practical application of the therapy on the man ot work on his own job. PNEUMOCONIOSIS The Committee has defined and described the condition of pneumoconiosis, or dust disease of the lungs, and ment ioned silicosis and asbestosis, as forms of the disease most interesting to railroad surgeons. Anthracosis (coal dust) and siderosi.s (iron dust) are ment ionetl as not causing serious complications. An entrance to service exiuniimtion is recommended particularly in those occupations where unusual quantities of silica or asliestos dust have lieen en countered or are contemplated as a routine occupational exposure. Sueh entrance to seivice examm.il ion- should include a complete occupational history, a careful physical examination, and an x-rav examination of the lungs recorded on film.-, for dmgiuwi- ami further record. It is further recommended that m jjeriodir examination- of employe-, with a history of working in noxious dust, who present symptoms suggestive of dust disease: 1) X-ray examination of the lungs should be done. 2) Change in employe's occupation should be advised or considered. POISON IVY AND POISON OAK Inquiries have been received from several lines as to the best method of car ing for ausw.ptihlv. sect ion workers ami telephone and telegraph linemen who have cornc in couIhcI with poison ivy or (Ktison oak. The only prevention known iipjK'tirs to bo the avoidance of contact with such growths. 40 Annotation of A moncan Railroad* trained dietician. 8{>ecia) diets on dining car* are not workable, hence not practicable. Any special diet is the responsibility of the passenger and should be selected by him from the regular menu. SPRAY PAIKTING Complaints of employes engaged in spray painting are apparently chiefly those of irritation of the skm, respiratory passage.*, and, occasionally, eyes. There arc a nurnb'r of protective creams on tf<: market, which can Is: applied to exposed skm areas before going on duty, that not only protect the skm from irritation, hut render any paint that gels on the -skin easily removable by soap arid warm water. When spraying in confined or impmjierly ventilated places, the employe should wear protective respirator. It* some instanre*, m a very small confined spare proviu'-d with only one ojicning for ventilation, a mask provided for supplying forced air from the outside is recommended. Goggles with easily cleaned lenv -. should furnish ad'-qualc protection for tlie eves. SYPHILIS Applicants for employment in the operation of train* and in dining car servire should be rejected who have clinical evidence ofsyphilis or a jiositive blood. JiltKxi tests should !* taken routinely. Periodic cxummutioiis of employe?. slionld nn lud' examination for active manifestation of syphilis. All employes with primary or secondary syphilis should be removed tem porarily from the service and receive treatment. Latent syphilitics should have a thorough physical examination, including spimd fluid tests, and treat ment discussed. Manifestation of cerebrospinal syphilis- is an indication for retirement. Kmploye.s with locomotor ataxia should be placed in non-hazardous positions. ArresU-d coses of neurosyphilitio should not Ik* returned to unrestricted train service. Persons receiving intensive treatment should be carefully reexamined later atul tlie results of these treatments evaluated. .'~. -5 In 19worked 1 than the tropics 1 treatmer lookout f The 11 others: n other nui problem. Attonti ployes us employes be exnmit of & tulx'r It h- ret fads it in duly, Ix-eii the effort c treatment It is rec wla-n, after are no clin consistent!; sufferer de< It is furt to service, . progression It is sug>. abeyance 01 in selected dilions an* TETANUS In wounds of a type where tetanus contamination is likely, prophylactic treatment may be given by oue or more of the following methods: (l)in wounds grossly contaminated with street dirt, the use of tetanus antitoxin is generally considered advisable; (2) in individuals who have been previously iI immunized by tetanus toxoid, a booster dose of tetanus toxoid is indicated; (3) at the present time it opjx-ars that the antibiotics afford the individual adequate protection against tetanus in the average wound. The use of anti biotics as a preventative measure carries less danger of untoward reaction than docs .the use of tetanus antitoxin. While tyj the control appear, parr Sept. 8, 195- Psr&typb* are etill quiu Tlie Coni;, should not lx repeated neg Family co. ing the perux d and the r crushed co and to d-O UUiHt develop* it \\A may l.ict that material, heat and ly useful, iperficial ft Report of Committee on Disability and Rehabilitation 39 Those who have come into contact with these toxie substances should im mediately scrub the exposed parts with an abundant amount of snap and water so ns to remove (lie poison before it ha* <tp|*mih>ty of jiciietratiiig tin; skin. Note--Attention is culled to the A.A.K. Manual of First Aid Instructions, i. * 1951, which states under the heading Poison Oak and Poison Ivy: "When it is known that contact with poison ivy has taken place, vigorous scrubbing of the skin with abundant, soup and hot water, wuthnt first hour or two after exposure may prevent any further trouble. The same treatment, if carriisl out within first twenty-four hours, often results m cun*. In later cases, treatment should be given by a doctor." ff practicable, ru.thing should be changed carefully. Oils (resins) from poison ivy or poison oak iruy be on the clothing from .same contact, and un necessary further spread may be made. POISONOUS SNAKE BITE Bearing in mind the necessity of securing the best medical attention as soon ms possible for administration of anti-venom serum, supjiortive and anti-shock therapy, it is urgent that certain first aid measures lie started immediately, as follows: 1. Apply tourniquet a few inches above the bite (proximal to wound). This must be released for 5 .->econ<ls at intervals of 15 minutes. 2. If proper type of anti-venom serum is at hand, it .should be admin istered at once in careful accordance with directions on the package. 3. Cross cut incisions entirely ihnmcb don .dwelt '4' deep and '4" to } _>* in length, and apply suction, Auction should be continued for at least 20 minutes out of each hour for a period of 13 hours, and the patient should not lie permitted to walk or exert himself in any way. Alcoholic beverages are harmful in snake bites. REPEATED INJURIES ("ACCIDENT PRONE") It is well-known that cert uti employes n-fwa/edly rejjort to the Medical Department for treatment of mpirn-x, many of which of enurse arc of a minor nature; whereas ot law employ'- hung l be -.woe i vjr? *<j work, -eldom, if over, Huff'-r an injury. ('on-idci-ai i>>n '<> ir.-.-i-n in the .nigge-rnui lb if. the <"hi i Surgeon'., Oflue k'-ep t file <.j employ.* aI.o have -offered pec-omd in juries on duty, a here treat na-r.f for -uch k.jiu;'-. h:w lutu given by the Medical Department. Where the record shows that any employe has suffered three or more injuries in on*; year, the attention of his employer could be called to the fact and his work habits investigated. SICK PASSENGERS Passengers who become iJl on a train may obtain the services of a doctor, at their own expense, by requesting the Conductor to telegraph ahead to tho nearest station for aid. SPECIAL DIETS ON DINING CARS Special dicta are individualistic. They vary considerably and with the allergic typee of individuals are extremely specific. Diabetic and nephritic diets are quantitative and qualitative, which require the supervision of a highly ,^n. / mi % Report of Committee on DixabUily and Rehabilitation 41 TROPICAL DISEASES In If'.'S the Oe:nmiitvV, stated, "Tropical Db'a'aci have; ;;eb-b!y Uon worked out to a better degree, three years alter the World War In the Pacific, than they were a year ago. The vast majority of those meA involved in the tropics have returned. They agqin have, adjusted themselves to whatever treatment is necessary for them in this climate. One, of course, must bo on the lookout for recurrences at any time.'* TUBERCULOSIS The incidence of tuberculosis ia no greater in railroad ecoployce than in others; Id fact, statistics show it to be leas prevalent than in employes of many other major industries. It is recognized that tuberculosis is a major health problem. Attention is called to the possibility o/ tuberculosis in clerical groups of em ployes as in other types of employment, and it is recognized that where such employes m clerical groups as in others appear to be below standard they should be examined to determine their physical state, having in mind die possibility * of a tuberculous infection. It is recommended that an employe who has active tuberculosis, and mani fests it in his sputum or by other accepted findings, should be relieved from duty, because of the danger of transmitting the disease to others and because . the effort on the part of the employe to continue work may interfere with proper treatment and recovery. It is recommended that; such employe be permitted to resume work only when, after thorough examination, he is found to be ao far recovered that th<re are no clinical or x-ray signs of active pulmonary disease and the sputum consistently free from tubercle bacilli, the case classed as arrested, and the sufferer deemed to be non-infectious to others. It ia further recommended that the tuberculous individual, after returning to service, should be reexamined at definite intervals, aa a precaution against progression of the disease and to protect the health of other individuals. It is suggested that all active manifestations of tuberculous disease be ia abeyance one year before a railroad employe be considered for reemployment in selected occupations, assuming that no other physical disqualifying eon- . ditions are present, TYPHOID FEVER AtfD PARATYPHOID FEVER While typhoid fever has largely been controlled in the Uaited.States through the control of water and food supplies, small scattered epidemics continue to appear, particularly ia the summer months. (Public Health Reports 65; 1171 Sept. 8, 1950.) Paratyphoid fever and other related enteric diseases (Salmonella infections) are still quih common and may appear in epidemic form. The Committee agrees that individuals suffering from these enteric diseases should not be employed as food handlers during the period of illness nor before repeated negative stool end urine cultures are obtained. Family contacts of such eases should not be employed as food handlers dur ing the period of contact nor before repeated negative stool and urine cultures 42 Attoci.ziior, Oj Arturrican ftailrooda arc obtained. (Sec Manual--Control of Communicable Discuses. American Public Health Association, publ. 7th Ed., 1950.) VARICOSE VEINS Varicose veins are due to defective valves and are not the result of trauma to the low er extremity. The presence of superficial dilated tortuous veins is not necessarily disabling providing the d*cp circulation Is intact. Employes with advanced vuricosilH x w ill do well t" we:ir an elu'tj<- bandage or stocking for the purpose of protect lm; tlx thin xkin m r tlx- Vi'in iig . in-r ;ilrn*Mn- ami i,l.., t" hUppm I the C;i jii/l.ii v fx c I "f 1i I. ill Jin-1 (Ini'- pi i .lit, or lit leas I. Jxi-d |mne, t lx: on'.i-t ivf Vnv*'tiv. 'i' uniiiii ns id i.i- r:*t !. I .igat mo id t hi- r nj H'l icml ij.iii in ;ii 1 lie hi > .in. : I t ),< kin - or ni iii h< i h vi i i ;in ai erpi ment , ix done und* i lur.i .int-'iln-.'ia and dm imt di.-able tlx long! ji uf liim . f h i in of treat patient for any WEED KILLING COMPOUNDS O|ior.'<torr usii.j' n *n'ti care. lend or other tome compounda should iw* due .r A A. Ai Ai Ac Ai Ac A bn Ba< 5 itii Bur Car Cat Cl,; ('hr Col a Cro Der Din' Diet Se Dint Hs Di#-> Dy* Se Elect lerican r.ituna , not - mth r the "A to ji'ine, rficial treat<r any e du Report o/ Committee on Disability and Rehabilitation 43 :> INDEX i.. Years ia which previously discussed by the Corn- Page niittee under same or Subject Number related heading Abrasions with Embedded Cinders______ 2 1929 Alcoholism....... .............................................. 2 1941 Allergy, Hay Fever mid Asthma......... 2 19(1 Amebic Dysentery.................................. . 2 1935 Amputations................................................... 2-3 1934 Antibiotics......... ............................................. 3 Arthritis * See Chronic Arthritis................................... Asthma 7 t See Allergy, Hay Fever and Asthma..... 2 ;i Back Conditions....... ..................................... 3-5 l928-29-31-32-34-33-36 (Back Injuries, Painful Backs, Sacro iliac Complaints ami Spodyln|i.sihi-%is) Back Injuries See Back Conditions................................. 3 5 Blood Pressure................................................. > 1923-25-20-27-23-29-30- 31 -32-33-34-3.5-30-37-39 -40-41 -40--17-43 Bums.................................................................. 5 1931 -34 Cardio-Vascular-Kvnal Disease...................... 0 1923-25-20-27-25-29-30- 31-32-33-31-35-30-37-39 --HM1-UV-47-1S i Cataract__ . ... n (`Iian oal llcati i A m Ih-frigi-i iti.f < ' ,i , ii 1925 20 27 28 i ('lirt-nic Arthnti< <`|nr \ imiat 7 i*:U-:w U (7 7 `'Common Cold" (Thr) and f'j>|K-r Re spiratory Tract Infections.......... 7 8 1934-39-41-17 Cross Kye-rftr.abi.imus--.................................... S Dermatitis....... .................................................. $ 1931-37 Diabetca........ ................................................. 8-9 1920-27-28-29-30-3I-32- 33-34-35-36-37-39-10-41 -16-47-18 , Diets See Special Diets on Diuing Cars._____ 19-20 ? Dining Car Employe Instructions; Food Handlers.... .................................. 1934 9 Diseases Due to Heat......... ...............--...... 9-t0 1937-39-40 Dysentery, Amebic i See Amebio Dysentery-_____________ 2 Electrical Accident*.________________ 192109-30-31 Emergency Treatment See First Aid and Emergency Treatment 11 Epilepsy and KpiJeplir Equivalent.- . . 10 1927-2829-3l-33-37-39 40--11 --If)--17 Kyc Conditions 1923-2.')- 27-28-29-30-3132-33-35--11-46-47--48 See Cataract.................................... Color Vision... -...................... . Cross Eye-JStrabiMiius.,............ Glasses and Guggle- ............... S 12 One Lye..... .............................. ... Fir.-t Aid and Emergency Treatment Foci of Infection....... .......... ...... ......... Food Handlers 17 It 1930 31 n 1929-30-31-39-40-41 See Dining Cur Employe Instructions F<*od Handlers................................. 9 Food Poisoning....... .............................. ...... 11-12 Glasses and (Joggles............................... 12 Gonorrhea See Neisscrian Infection (Gonorrhea) .. KM' Gout See Ciironic Arthritis......... ................. 7 Hansen's Disease (Leprosy).................... 12 Hay Fever See Allergy, Hay Fever and Asthma..... 2 Head Injuries........................................ 1129-3143-36 Hearing Defects and Testa....... ...................... 13 1925-28-36*46 Heat Cramps, Heat Exhaustion, Heat Jlc- tention, Heat Stroke See Diseases Due to Heat......... ............. 9-10 Heaters See Charcoal Heaters in Refrigerator Cars..--..................................................... 6 Hernia_______________ _______________ 13 1936-41 Injured Employe................................... . .... 13-14 1929 Leprosy See Hansen's Disease.. ................... .... 12 Malaria.............. ....................... ................ .... 14 1925-27-29-30 Man-Failure................ .................._........ .. .... 14 1940-41-46-47-48 Mental and Nervous Disorders............. .... 14-10 1923-34-37-39-40-46-4748 Narcotic Habitues.___________________ .... 16 1929 Neisscrian Infection (Gonorrhea).......... ... 16-17 1946 N< Ol O: Pa Pu- Per IV Pni Pm Po. Rei S. Kep SC! St Sick Snui S< Spet Spor Se Spra Strv Se Suns Se Sypi Teta Trop Tube Typl Uppe See Vuric Vsscii See Weed iously Coraie or ; 39 o-3i,h \7- Reporl of Cotnmillre on DuuiMity tuul Rehabililnlujn 45 j; INDEX (Continued) Years in which previously E discussed by the Com it Subject Page mittee under same or Number related beading f Nervous Disorders See Mental .uni X<rv<>n Disorders U U> Obesity....... ......................... 17 1928-35--10--41 1 One Kye..... ............................. 17 i Painful Back* ) See Back Conditions................................ 3 -5 Paratyphoid Fever See Typhoid Fever and Paratyphoid 1 Fever....................................................... 21-22 Peripheral Xerves....... ............................... 17 1934-37-40 Physical Medicine......................................... 17-18 1930-35-41 sf Pneumoconiosis............................................ 18 1932-33-35-37-39-40-41 l Poison Ivy and Poison Oak. .................... 10-19 1932-39-40 W Poisonous Snake Bite.... ........................... 19 1931 Renal Set Cardio-Vjvwular-Henai Disease .... 0 f Repeated Injuries ("Accident Prone")....... 19 1929 Sacroiliac Complaints See Back Conditions....... ......................... 3-5 , Sick Passengers............................................. 19 1927 Snake Bite k See Poisonous Snake Bite......................... 19 Special Diets on Dining Cars........ ............ 19-20 1929 Spondylolisthesis See Back Conditions............................... 3-5 Spray Painting............................................. 20 1931 Strabismus i See Cross I-,ve-Stjubi-nius.... 8 j Sunstroke See Diseases Due to Heat.. MO Syphilis...... ..................... 20 1923-24-25 -JO-27 28 -29- 30-31 -32 33-34-35-80-37 -39-40 41-10-47-48 Tetanus.................................... 20 1920-27-U Tropical Disease*.......................................... 21 1947-18 Tuberculosis................................................... 21 1920-33-34-39-W ! Typhoid Fever and Paratyphoid Fever _ .. 21 22 1940 Upper Respiratory Tract Infections See "Common Cold" (The) and Upper Respiratory Tract Infections....... .. 7-8 f Varicose Verna........................ ..................... 22 1940-48 * Vascular *; , See C&rdio-Voacular-Renal Disease...__ 6 Weed Killing Compuunda...-................. ..... 22 1929 46 Association of American Railroads (A number of comments and suggestions were offered by many of those present in general and substantially off-the-record discussions of the vari ous subjects referred to in the preceding Report.) The Chairman: Thank you, Dr. Slack, for that very fine report. As you will note, gentlemen, a number of Advisory Members were also assigned to this Committee to facilitate the handling of this report. We confined ourselves pretty much to the Chicago area because there were a number of meetings, and wo didn't feel it was well to call men in from different parts of the country when wc had the rather generous help from Chicago. They .'pent many iwjmm from five: o'clock in the evcniDg until ten going over all the trausaciioti-'. and tin.- i- iimir or !<- of a brit f abstract. 1 want to thank J >r. Sim-k mid In- nummtii c for the fine work and also I wa- going lo r-.i*- Dt. Jn-whm.-' haw iilim.-l mitde a doctor out of him because hi ha- iiia tide d all of tm - mi-ling-, and that is wlmt h:i- madf this repoti Wi. wdl have oiimm m- now that, have been offered here, and tin rfiiijto111 i m \i yi .u can mala -iipph tneul- or changes in this a* they ,-ct fit. Are there any oilier comments on tUn- report ' Dk. K. E. Do" u (Chief Medical Officer, Canadian National Railways): 1 ju.-t want to say it t- a very excellent n-poit, Mr. Chainnao. That is the biblc that we can follow pretty well in the future as far as disability and rehabilitation i- concerned. 1 think this was the committee that Dr. Garner used to handle no very well, and it is an excellent report. 1 think Dr. Stack and his committer deserve the very highest commendation. The Chairman : Will you make a motion to that effect? Du. Down: I culainlv will. (The motioii wax duly seconded and carried.) The Chairman : All in favor of accepting the Report of the Committee on Disability and Rehabilitation as presented will say "aye." Contrary? Accepted. Next will be Item No. 6. "Progress Report on Activities of Joint Com mittee on Railway Sanitation," by Dr. Graham. Dr. R. M. Graham (Director, Department of Sanitation and Surgery, The Pullman Company): Gentlemen, as many of you know, Dr. Hursh and I have been members on this committee representing the Medical and Surgical Section for some years. We are sorry to lose Dr. Nance who ht*- r'-igned from rmlrn.id sivicc. Dr. Clayton has recently been appointed lo f.'ikc hi- pi.H i (Dr Graham bun n ml In- n-pi.it a>- f..ll<>u- ) Report to Medical and Surgical Section on A.A.R. Sanitation Research Project Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation Dr. R. M. Graham. Director, Department of Sanitation and Surgery, The Pullman Company, Chicago. Illinois. Dr. M. I). Ciavton, Chief Surgeon, Southern Railway Svstcm, Washington. D. C. Dr. A. M. W. Hursh, Chief Medical Examiner, Pennsylvania Railroad, Philadelphia. Pennsylvania. 'f & St "E mpr ta: Wf. ni th nc to ptr an ) of wa era A lot SU! tin tot sol st\l V on. op fre ID'-. Vt ye 1 pi i fro var in]! \ sixflur sup any of those if the van* i report. As J.'O HSMfCfled vVc confined c a number <rn difbroiit -in ('lm-ago. l! [c fl going ract. i k kUo doc out of .i what has iTercd here, i in this as Railways) . Hiat the ibi!: ad Dr. O Dr. b. -- g ' >mtniUep I 'mitr.iry'.' nt Cum- ir Hu.-h M-'dieal nice a ho pointed R. he ry, The hington, .' ailroad, Proceedings of Medical and Surgical Section 41 Ry Dr. K. M. Graham, Director, Department of Sanitation and Surgery, The Pullman Company Many of you will recall tlie paper by Dr. Woiman and Mr. Clark on l "Human Wastes and the Railroad Pa-wnger Car" presented at the 1918 meeting of the Serinm and report* d in I In' IVoeei-ding-', aiut alrsO their paper presented at. Kdgew.xJer Park l.nt ce.ar ou ''Some Problems in General Snii- iilinn m R.olmid J'lau-por' ii'."ti." Tin; A.A.K. .*-.11111.111011 Iti--i- iirli I'rojrct, ii> ,-tudy the problems of -r-wnge wastes from r.adw.nv nr--, nnd' is.ikrii under tin: direction of the Joint. I'nuinutter <n Raibvav Sanitation, on which eommittve arc three members of the Medical i Surgical Section, was started in 15H6 and completed last Fail. There have been eight. Ter.hmcnt Reports prepared by tho Project person nel from their observations, studies and experiments. All, except one relating to the numerous patents on devices for handling the problem, have been published for the benefit of the Railroads and associated interests, and I am sure that many of you have already received copies of these reports, which relate u> the .Mibjccu of toilet requirements, usage, and disposal of toilet wastes. A nummary report of the Project Director and the Committee on Rail way Sanit.iiion of i)u> findings and noneluu*nH has !>oen made to the Gen eral Commute!- nf the A.A.K. A.summary of a t.-iv of the findings and conclusions reached will be of interest to you. Although many devices were tried, only one seems to have some merit sufficient to warrant fur'licr study. This is a rubber sphincter valve in the hopper clm'>- which could In- u.-.-d to temporarily withhold discharge of loilet wastes .u certain d'-itrd locations. There are still a number of un solved quistions relating to its practical usefulness, which require further snuly md in d. \'o vide.-!- ,, s i- i.ijri-1 '!,a' -i-w ige w ..te.< from railroad ears have <vtsc<l onibrf-aks or ;; 1< niof 'ornmnnic ibi'- disea-e, nor was evidence devel oped 'lio vmg known h umful emmer-ir n U-uvr.-en sm-h waste and disease. The total amoiim of iV.-.d -ohds discharged to the railroad right-of-way from passenger trains i.t exceedingly small, comparatively; and wan cstinuted from die finding-- of the Project, to .iv. rage for tho total of all pas-engrrs in die I'mted States lew than one ounce per yard of track per year. Bacteriological studies, as reported in Technical Report No. 6, on tho presence of indicator coliform baetena in railroad ballast, water run-off from roadbeds, and in the aiinosphere of fx- moving trains, showed little variation from other environments that are not considered generally to be injurious to health. No evidence was developed to justify the contention that toilet wastes should be retained on cars; with the exception that toilets should not be flushed at spots directly connected with the furnishing of potable water supplies. j^ `Itiifriiti laftwirtlHt-lTan -If r-zm '/. " 48 AMOciation o/ ^mcricon Railroad* With regard to potential hazards from track pollution, may I quote from Dr. K. F. Maxcy's epidemiological study, as reported in Technical Report No. 2 of Nov. 1946. "in view of those considerations, there appears to be good reason for modifying the original hypothesis and concept of railway sanitation which trace their origin to it. At times and in particular places the disposal of sewage has been improper in relation to environment and persons and. therefore constituted a nuisance. This has not created a hazard which can be measured in terras of increased incidence of enteric disease. Facts now avail.-ibh support the conclusion that this practice has been rela tively unitnpo.-r_,i,; in compin-ou with many other factors in the environ ment wim-h an ic -pon-il.b for tin- maintenance and dissemination of t-nWin iiifi r iK.ii -111<) di-in-e in human lonimunilh* u/id* i conditions which h:vi iii ;m- United S'.-itf-." Di. W olman In ought to your at tent iuu in tin- meeting last year an out line t.f major piobhm- in r.nl.v.n '.nutation. I think it i- the duly of all of u- who an coiici u,i it null ),)- phn-e of railroad operation- to give seri* our. roiwdcraiurn to piavucnble methods that 11133* improve the sanitary as well a- olh' i -afetv fc.ilun- of micIi operation-. ,V- noted m i!.*>I 1 * |mi 1 of tin- (`(iiiimilHa on Dtsahihi.v and Rchabitilntion under tin- subject of "Food Handlers," the U. S. l'ublic Health Service is contemplating the issue shortly of handbooks covering sanitation features of Dining Car- in ()|ienifinn. Railroad Pus-engcr Car Construction, and Railroad Sen icing Area-. In this matter, the Service has called on mem ber railroads and the Joint Committee on Railway Sanitation for criticism and advice. It r- contemplated that such handbooks will cover in some detail various subject- covered in the Interstate Quarantine Regulations, and will largely supplant the Sanitation Manual for Land and Air Convey ancer Operating in Interstate Traffic, published hy the U. S. Public Health Service in January ]{W3. {There followed a brief. otT-tbe-record discussion in connection with this report.) The Chairman -. Orntlemeij, we wilt now go on to Item No. 7 on the Program, the Report of the Comniinoe on Nominations, winch will be pre sented hy Dr. Davis. Chairman of that Committee. (Report of lie Committee 011 Nomination-, the balloi foi Member- of Committee of ) >11-<-11< <U. and eleel 10I1 of .Member- of Com ill IM ee of Direct ill) I are included m rrear of t}> - 1'ioeei dint- 1 Cl'he meet mg 11 ee--. II 4(1 o'clock I ANNUAL INFORMAL LUNCHEON Drake Hotel, 12:30 P.M.. Monday, April 2 At the Anmtnl Informal Luncheon, Dr. Arthur R. Mel*. Chairman, Medi cal and Surgical Section. mumimed the (ine-i Speaker. Mr. John 1*. Kilev. President. Chicago. Milwaukee. St. Paul and Pacific Railroad. The Chairman: I once heard a story about a railroad president who acted very high and mighty. He ordered a private elevator installed to hia ss# T? Yc tirr fnW, pu ma n>. wn mu Cot 191. Hill he wen wor nee time joint In the gene Sent and lake 1st A givr the and R off IK hi ness to * rail I pou 3 'ora >ort bo vay .Cl'S tad tnl I l.i* OU- >.i llll niall Tliry 'a* ice 'C* 1 in yii .1 n \ 8 K Xr Proceedings of Medical and Surgical Section 49 offices, and no one else was allowed to use it, oo pain of immediate die- missal. An employe of the railvoad who once had the nerve to pay hollo to him on the street next day received a curt note from the president's office to the effect that in the future he was to refrain from taking such liberties. It is my privilege now to present to you a man who isn't like that at all. You know, we doctors don't make any money for the railroads, but every I time I have occasion to go to this m.in' office, lie greets me in a very friendly mariner He mils mo hv my fir-f. name and I call him by his. We get along very well indeed, This fricndlim--. louplcd with j.h-iuv of ibditv md drive, are what have put tins man where he is tod.iv Hi.- rare. r w another rvauiplc of how a \ man can start a' ihe bottom here in America and by applying himself, n-e fight to the lop, lie has hi- enluo working life on The Mil waukee Hoad. A native of Chicago, he worked as a rodman and instrument4\ man for the Road during -summer vacations while a student at Villanova 5 College. Villanova. Pennsylvania. TTpon his graduation from Villanova in j 1915 with a degree in civil engineering, he joined the engineering depart (i ment on a full lime basis, doing valuation work. World War I broke into his career. Entering the army as a private, > he came out of service a .second lieutenant of engineers, and immediately i went back to his job with the Milwaukee. He continued to do valuation work for a time, then was transferred to the finance department as engi neering assistant. Later, he shifted to the operating department and con tinued in that department until he was uuule auditor of investment and joint facility accounts. In 1942, he was again back in the operating department as assistant to the general manager. Lines East. A few months later he became assistant general manager. Lines East. After three years in this post, he went to Seattle where he spent two year*: one year as assistant to the president, and one year as vice-president. He returned to Chicago in June, I94S, to Pike over rho job a* vice pre-ident in charge of operations. On September * 1st last year, he rt*-mwd hi* pre-ent dnfie*. V* von . .in vc If- ii.i- a *>i.r.i,| klea l".Ji'c of i nlr'i.i'liiig and f dunk our uiihoad i- foitiuiaic ,n having him m hi* pii--nt po-ifton. Cctulemon, it gives me great plca-me to introduce to v<m Mr John Kiley, president of (he Milwaukee Road. John, the Itooi is voui''. . . . (Applause) , Mr. Kii.:y: Thank you. Art. Mr. Chairman, distinguished guests, ladies and gentlemen. , . . Railroads move a lot faster than in years gone by . . we've cut hours off schedules in many cases ... on some sections of line wc. run trains it os little as five-minute intervals . . . the entire railroad operation nowadays is based on speed ami efficiency ... it has to he, if we are to stay in busi ness. In assigning the reasons for this increased efficiency, we are very prone to emphasize the mechanical improvements. Diesel locoraotiveel Heavier mil! Better roadbeds! Modem yards and terminals! Much improved communications systems! These arc the things we're apt to mention. I wonder if we aren't forgetting one all-important element--better manpower. Casey Jones may have been a mighty good engiener by standards n -*rwi'lift* taftrtfVi'% ilftriI, 00 Auociation of American Railroad of his day, but 1 wonder bow be would have stood up in the cab of a big diesel hauling a modern passenger train. For all we know, the famous Casey might have been color blind ... he might have been subject to i epileptic fits ... at any rate, be was taking risks on his last night at the throttle that suggest his judgment wasn't all it should be. In every department of modern railroads, and particularly in the opera* ting department, physically fit, well-balanced men are an absolute neces sity. Whenever a tragedy occurs which seems to involve a human failure, 5 we are sharply reminded of this fact. And this is where you men who are eittiDg here in this room come into the picture. I sincerely doubt whether our highly organic d . . . highly coordinated modern railroads . . . which demand efficiency and teamwork fiotn so many different individuals . . . could be properly run without lh< rarr-fol medical supervision of their per sonnel. Yes, contribution is very great. He cause much of your work is done behind the scenes, o to -j-ink, you may sometime.- feel it isn't sufficiently appreciated. You may feel like the man who never got credit for anything. No matur what hr did, someone el.- ;dwa.v.- gof the praise. He felt so miserable that he finally decided to tak>- his problem to the Lord. Uc hud never been much of a praying man, and he fell Nelf-consciuu* about getting down on his knee- in hi-- home whem someone might Bee him. So he took a walk into the country, looking for a lonely place where be might address a good, strong petition to the Lord without being inter rupted. At length be came to a field where he was absolutely alone. There wasn't a person or & house in sight. He knelt down, glanced cautiously about. held out his hands in an attitude of hupplu-ntion and began to pray. Ju6t at that moment a bird flew over him, and in passing performed that certain rite common to all creatues. It was a bull's eye--smack on his out stretched hand. The man looked at bis band, then gazed up at the sky in anguish. "See what 1 mean, Lord? For some people they sing!'' Just in case you feel like that man, I'm going to sing your praises. It is an easy thing to do because the records point out what you have con-, tributed to safer railroading. Between 1918 and 1949, the rate of fatal accident* to employes on all Class I railroads decreased 91 per cent, reportable injuries declined 87 per cent . . . and the casualty rate declined ?e per cent. In the case of our own railroad for the same period, fatalities dropped 8ft per cent . . . reportable injuries 91 per cent . . . and the casualty rate. 80 per cent. This is a magnificent showing and ii big .-hare of the credit for it belongs to Use surgical departments of our railroads. I recently read a statement that five times as many conductors were killed on duty in 1S90 as in 1940. Due to your efforts along with those of the safety departments, great strides have been made toward making railroading a safer occupation. Perhaps even more significant than the decrease in fatalities is the tre mendous reduction in man-bours lost due to injury. Literally billions of man-bours have been saved through proper first aid, proper and prompt hospitalization and the scientific care given injured employes, in case of accident. Better work habits, by preventing injury have, of course, also played their part. - In the case fell they dec be avail:, injured < company lion and matter b or correc ploye co: has recov We be. of view, 1 aible race his work r. more th; WheD 7 got along were org:. feet migb find out w hearing w. some of t It was a instituted name will outstandin succeeded death in lc of my frie In Art'.which aiw cabinets e 15.000 of cemod wi doing ever tious. I k that it's a The M roads was held in Ju surgical d own case, at various 15.000 docu as members The accoi require far -ub of a big the famous i subject to night at the 1 the opera'flute necca* run failure, K'a vvho arc ibt whether . . . which . iduul* . . . if their per* ork ia done sufficiently >r anything, fie felt ao "d. f-cooHous m; see dace . ing :iere wasn't :ily about, :>ray. >rmed that '0 his nutit the .<ky r I" miU il.lV.' p-..U- .'s ,,n at ,i a .sr /r i mir own reportable it belongs statement t in 1940. at strides t the Ire* illioos of l prompt v case of tree, also Proceedings of Medical and Surgical Section 51 la the old days on our railroad, the responsibility for handling an injury case fell upon the division superintendent and the claim department. If they decided medical care was needed, any local doctor who happened to be available was called in. Under the present system on our railroad an injured employe is immediately sent or taken to the nearest designated company surgeon and hospital. He is given a complete physical examina tion and X-raycd for po--ibh* hone injuries. This procedure is followed ao matter how -light rhe injury appears. In the more severe cases, surgical or corrective unu.-urcs .ire laki-n to redm-c disabilities. The injured em* ployc continues under the jurisdiction of the surgical department until he ha3 recovered and >.i ready to return to duty. We believe this system is not only far better from the railroad's point of view, but from lhat of tin: employe as well. He is insured the best pos V- sible medical and surgical care from the very start, and is able to resume his work and earning power at the earliest possible time. Without doubt, in } more than a few cases, this procedure has prevented permanent disabilities. t When I think of the old days, 1 sometimes wonder how the railroads got along without you gentlemen. Before medical surgical departments were organized, almost any two-legged man not obviously dying on his feet might be hired for an operating job. There were no examinations to find out whether he was color blind . . . had a bad heart . . . whether his hearing was as good as it .-hculd be ... or whether he was suffering from some of the many other diseases the fle.*h is heir to. It was a red-letter day on our railroad when physical examinations were r instituted in 1915 by Dr. Albert I. Bouffleur, our first chief surgeon. His name will be familiar to you as that of a leading Chicago surgeon and an outstanding clinical professor of xirgerv at Rush Medical College. He was i succeeded as chief surgeon by Dr. B. F. Lounsbury, and upon the latter's death in 1927, the responsibility <f this important office fell on the .shoulders of my friend. Art Metz. fa Art'.- /dice ii.- a mind .-r .d liliuy .-ribim-ts standing in a. ucat row vtucli always giv>-s me .1 'rmll { j M;:.-inrc ivhi never I ->-e The . 'ihiDCt.s euijtain the r**,<irds periodic phy-ural examinations of .-ome I.>,000 of our people wlm-c a ork i< in one way of another directly con cerned with the running of trains. Those cabinets tell me lhat we are ft- doing everything we can to guard against human failures in our daily opera tions. I know I speak for till of our administrative officers when I tell you that it's a mighty good feeling to have. The Medical and Surgical Section of the Association of American Kail* roads was organized in December, 1920, and the first general meeting was held in June of the following year. In the past 30 years the medical and surgical department of the railroads has been greatly expanded. In our own ease, our medical and surgical organization inculdes 750 doctors located at various point* along our lines. Throughout the country, no less than 15,0001;doctors give part of their time to the care of railroad employes as* members of the medical and surgical staffs of all Claw I railroads. The accomplishments of your organization are so numerous that it would requirw/far more time than I have at my disposal to list them all. Here is just, one example: Back in 1925, an eastern railroad arranged for the tmnAitr*8im>iVln i >. -Pr,; A- 52 Allocation of American Ra&roadt physical examination of 5,393 of its employes. Officials of the railroad were startled to find that 51 per cent of these employes had disabilities serious enough, if not checked, to shorten their economic usefulness by from 5 to 15 years. However, by following the advice of the railroad's medical depart* ment, 80 per ccnt--pracikally all--of those with disabilities were cured of them and became physically fit. Examples such as this could be multiplied many times, perhaps out of your own experience. I have never had any medical training. 1 am an engineer by education, and my particular bent took m<- into fields far removed from m< dinne. Hut 1 can see results, and judging from results, your work hr*.- }<< n of immense tise/uless to the railroad-, to their employeand to soejcly. Through careful screening of applicants for railroad tram service jobs, and permdm checkups of the men aftcT they are iu service, tlit- average physical condition of these employes has certainly been raised. Sir William Osier, Kngli.-h physician of pleasant memory, once said of the human i.ui "Thin- are no ,-:i:oght barks, no symmetrical faces, many wry noses und no even legs. We arc a crooked and perverse generation." With this to work with, 1 should say that you gentlemen have done pretty well. . . . Sir William also is credited with having made the remark, "There are only two sorts of doctors, those who practice with their brains and those who practice with their tongues." You have always been pretty modest about your work and its importance to the railroads and to the community, so 1 guess it follows that you've been doing your practicing with your brains. . . . You are 'way ahead of me on the facts of medical history, but you may be interested in the impression a layman gets when he reads the annals of your profession. Everybody knows about Lister and Pasteur and Harvey, but there have been many other courageous innovators whose names are not so well known to laymen. I happened to pick up a book the other day about the history of surgery, and I came across many names that were new to me. For example, Andreas Yesalius, who I believe is recognised as the father of anatomy. As >,<inderstaad it, hb great work on anatomy completely transformed the practice of surgery. Another name 1 recall is that of Ambroise Pare, who believed the prac tice of burning a gun.-hot wound with a hot iron to keep it ''clean," as they did in his lime, was cruel. In treating certain wounded soldiers, he tried a miid pack made of eggs and herb.-, and that night couldn't sleep because he felt he hiul betrayed hi- profession. 11c was happy next dav to find that the wounds ho had treated in his own way were clean while wounds which had been burned were festered and inflamed. What these men and others accomplished with little or no knowledge of physiology and none of antiseptics reflects enormous credit on the medi cal profession. The thing that strikes me forcibly is that they had two outstanding traits--human kindness and an intense desire to advance the cause of medicine. These characteristics are to be found in your organization, too. Not con tent with applying the most modern accepted methods of surgical practice * -t; and wor be i repc ber way to I ID wor. por; rui-. givi: 01 II I do* rail i fried Ar of t) a nu. dawri Et and ' cal d pi Cal was t in Fr body there. O the d Af! -crvu j- us ing On a be flu conic: cago ' eats h be is ythcr I al practif consid -oad were a serious .ora 5 to *.1 dep&rtcured of h out of l am an iclds far i results, mployes :ui tram service, a raised, said of 3, many .-ration." e pretty ;ere --' d ti mode* jnity, n your <u may nals of larvey, are 'r day : were xnizi-'i k!>mv pracu," as is, he sleep : day while ledge uedt- two ; the con* ctice * Proceedings of Medical and Surgical Section 53 <* % and healing, I know that you have a number of committees constantly at work investigating now procedure* and now Holds in which you foci you may be of service. t I am informed that you have before you for approval at this meeting, a report dealing with the most up-to-date methods of treating a large num ber of conditions and diseases. The subjects, I understand, range all the way from the common cold and the correct treatment for cinder abraious to amputations . . . allergies . . . burns . . . alcoholism . . diabetes . . . eye and our defects . . . hernia . . . tropical diseases and many others. I note also th.it nervous and menial ailments as they relate to railroad work are carefully examined and that due attention is given to the all-im- porumt problem of man-failure in connection with train accidents. To me, os a layman, this all means that your organisation is on its toes . . . giving your railroads the benefit of the most modern thought in the fields of medicine and surgery. For my part, I am happy to rest this important phase of railroading in your capable hands. I do not feel I should let this occasion go by without paying a well- deserved tribute to an able and conscientious man who has served our railroad faithfully and well for nearly two score years. I refer to our good i friend. Art Met*. Art Mets is a Hoosier. He was bom on a farm, and he still has a lot of the farmer's ideas about work. In fact, I have a suspicion that he thinks a man is loafing unless his day's work extends from the first glimmer of dawn until after dark. He worked his way through a five-year course at the University of Indiana and then went to Hush Medical ('(dirge for two years, receiving his medi cal degree in IUU. He sj>ent a year and a half in Cincinnati General Hos i pital us an interne, and in 1913 became assistant to Dr. Lounsbury, who was then chief* .-urgeon of our railroad. His first salary was $75 a month . . . 1 wonder wIm-iIht Ins prr-<-nl -alary buys any mure. . . . Art -iiein IS imunfis :u the army m World War I, a year of that time * iu France. He returned to his job with the Milwaukee Road, hut -nmel.udv uiicci 1 Mm ,r.\.iy on i Imj ;nnr Mini m .\/u<-a. lit: -pent six months ihen*, returning with a box ear load of uopines, some of which you can -ee on the walls of his office, lie'll talk about that hunting trip, too, at ihe diop of a hat. . . . After Dr. Loun-lmryV death, he became our chief surgeon. While ably serving in that -apaciiy, he lias found lime for many other activities. He is associate prob -sor of surgery at Northwestern University and any morn ing at 7 30 you'll find him at Wesley Memorial Hospital, where he carries on a full operating schedule. In his spare time--you might ask him where he finds it--he is a yachtsman. With his R boat "Olive" he was a strong IV contender for the I.ipton Cup, and in 1937 he was Commodore of the Chi cago Yacht Club. Incidentally, he is a bachelor, never smokes and never cats lunch. Maybe he's got something there, for as you no doubt know, he is the author of "The Time Table for Reducing" which a number of other railroads and the AAR have adopted. I always enjoy chatting with Art because of bis kindly philosophy. He practices what he preaches, too. He treats a track laborer with the same consideration that he treats our highest administrative officers. ... /iintmiwI.^ >-3 lilirftr a...., 64 Auociaiion of American Railroadt Through his hard work, kindliness, wise counsel and high professional skill, Dr. Metz has made an outstanding contribution to our own medical and surgical department and to the cause of railroad medicine generally. He has served your organization faithfully and well. Under his guidance as your chairman and also as chairman of your committee of direction from 1941 to 194G, and also during the year just past, the Medical and Surgical Section has made substantial progress. 1 know you join with me ami hi' many, many other friends on our railroad in tendering lis. M< sz oni <h i ).<; thank.' for bis line m rvn < . SECOND SESSION M.-mi-,;. Apnl 2, H*.M The itn-crinsi iiwonv. m d Arthur K. M< :z, pu -uiing tin oVl < k at tin Dial.- Hotel, Chairman Tm. C'ji mi.msn : Tia no t mg v. ,.i v<ni* u ordi i The Hex! ium t>n lli.- jiro^r.iin i- th. piopM^d revi-ion of "Regulation' ami Kef)uireiiieni.- Cov. ruing J'f-yJ i;.\a/n.i;ttioiis, including Sight. Color Sense and Jluring Toy. fm lanane, ;o Sirvice, Promotion, Periodic and Special Examination'. wilt. Method of Conduction,*' as drafted by the Committee on Developments Resulting from Physical Examinations. Dr. Iiennett, as Chairman of that Committee, will present the report. I)it. Runmitt: Mr. <'hah man, t lenth-men, I might stale before wo go through tin.- i-poil that the f'ui:iin,t l<- r. rtairily contributed a ptent deal of help and Migg. -lion- u< d: I other Chief Surg-ons in the drafting of this proposed revision. We originally got it log.-iher in a mimeographed form, of which there were about :#) to 40 pages, and in that we included every thing that was in the <M regulation- 'l'o that wc added all tin: suggestions, all the thing- which we thought might he of value. Then with the whole committee going over this total ilia's of material, we struck Out what we thought was not applicable, ami left in what we thought was applicable. Of course, as you know, tin regulation' are not binding to you. They are only as suggestions, and v-.u can u?c them as you sec fit, but it is certainly fine to have down in black and white somewhere wbat the Medi cal and Surgjra! Section of th< Av-ociation of American Railroads considers to be reasonable regulations for physical examinations having to do with pr< -employin' tit, periodic, promotion ami special examinations. tHr. Hfuiut: then i.-ad through the piopovd revision of Circular No. M.kS-218, as follows.) Proceeding9 0} Medical and Surgical Section 55 (PROPOSED) Circular No. MA3 -------(Superseding C>r. No. MAS-2 1(1 D*led M*y 31. 193ft) ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS CotamRtt# Member* Dr. R. J. Bennett. Jr. (Ch%lrm*a), Clviel Kurgeca, Elgin, Joliet A Eastern Kailway. Dr. J. J. Brantlabur. Chu-f M.-dioul Ex aminer, Chesapeake A Kailway. Dr. 75. I. Derail/, Chief Surgeon, North ern Pacific Railway. Dr. 0- H. Horrall. Chief Surgeon, Chi cago, Burlington A Quincy Railroad. Dr. K. C. NValJen, Superintendent end Medical Director. Relit,f Dopsrtiuont. Atlantic C"a.st t.ine Kjilrirad. Dr. R. 3. We.tilioe. Chief Surgeon, Chi cago A Eastern Illinois Railroad. Adrisory Member* Dr. R. M. Graham, Director, Department of Sanitation A .Surgery, The Pullman Company. Dr. 0. 0, Ouy. Chief of Surgery, Chi,-ago Hospital, Illinois Central Rail road. Dr. U. lIoiixehoMur, A**i*(nt Chief RurU'.'.n (I.me* Kant), Chirago. Milwau kee, St. I'aal A Pacific Railroad. Dr. TV. W. Leake, Chief Surgeon, Illiooia Crntral Syatem. Dr. J. K. S'A-'k. Chief Surgeon, Chicago A X,,r*>i Weatnrn Railway. Dr. A. R. Mol* fet-ortleio). Chief Sur geon (Lines Kaxtl. Chir*go, Milwau kee. St. P\ui A I'acifle Railroad. Chicago 5. 111., April 2, 1951 To the Medical and Scitcic.a Teuton' : fn i -'Orif a; <. witK vtii.n t.k. n l,v :lu ( '..mun't, c ,( Direction, your Committee on Developments Ho-ntltinsf from PhyM<v\l Examinations met in Clii -igo. Jii.tr,in, ,n .1.inn try >>'li, ill'll. tu -Ir iit. a .--vi-ion of (Sn-ular Vo -M.v."i-JIti, U iy .{I. < lining 'If- gul.uinu.H hu<1 R<-<pirt:- ttu.nl.s < lovci n>ng I'liy-; ;:ij K.vmiiu.tlion-t, Im-Incling Sight, Color .Sense and Hearing To-'is. ior Knlr ut:-,.- u> ('r-ininlinn, I'.tn-.lic >nd Special Examinations with Method of Conduciion." The "Regulations and Rcriuircnicnt.-i" referred to -.vero originally approved in 1925 and Operating Division Circular D-l-60 of February 25th, 1926 issued to cover. Under date of May 31, 1939, and as a result of experience arising from the application of the standards referred to and recommendstions received as to changes therein, Circular No. M&S-2I0 was issued on behalf of the Association and contained the recommended "Regulations and Requirements" as revised at that time. Ia light of further study of these recommendations and comments re ceived from time to time from members of the Medical and Surgical Sec tion, it was deemed desirable that Circular No. M&S-210 now be revised to bring the recommendations as up to date u possible. Included herein. { J j ~n aw. ' i ,mSSan^ tuti rt.-ini<Ay tiijuri -jfriitfiri 56 AttocicUiun of American Railroads accordingly, are the proposed, revised ``Regulation? and Requirements Gov erning Physical Examinations, etc.," as approved by the Committee of Direction, Medical and Surgical Section, and this Report is submitted for consideration and discussion by the general assembly in session at the Annual Meeting of the Section in Chicago. Illinois. April 2nd, 1951. It is pointed out that ihi>- revision has yet to be placed l>efore the General Committee, Ojieriiling-Tinn.'poiiulmti iJivi-iots. of tin- A.A.H.. for review and approval by that ('r>iniuinr< lufon )< can l.< enri-idru-d a< "him!" and be ui.-ide a\ail.[l<l< foi uinei.il di-itdwitmn Respectfully Mibmiiti d. Comsuttkj on Di:\ni^U'Mt:sTs Jti>ir.Ti.vo Fim'i I'JiVSKU. fvUMIV.UIOSS, R J. Jh ssf.tt. Ju.. M.D.. Chairman Regulations and Requirements Governing Physical Examinations, Including Sight, Color Sense and Hearing Tests, for Entrance to Service, Promotion, Periodic and Special Examinations, With Method of Conduction. f GENERAL RULES 1. Applicant.' for employment in ronm-i-iinn with the handling of engines, trains, or marine equipment as enumerated below, and also applicants for such other position* a1 may be designated from time lo time by the rail road management, must pas a satisfactory physical examination before entering service, including an examination of sight and hearing. Applicants for positions in train service, and all other employes who. by reason of their occupation, arc required lo interpret color signals, must also pass a satisfactory examination on colors.* Cfoa* A. Enginemcn. Firemen. Muinrmon, Minornum > Helper-. Conductors, Train Flagmen. Train Baggagemen. Switchmen, Brakemen. Train Porters and all other.' who have any duties in connection with t)w operation of trains ('lux* li. Signal KejMiniien. Kuinpmeu (Signal >. yar*lnui.'(eis. On pou ter.' on line woik. Ifollei>. Smium Railroad Crossing Watehmett. Bridgi Watchmen Wreek Fen men. Tiaek I nreuu-ti, Mo"rii- gers who'e diMie- involve dang* i from m>\ mg trams. ('hnufleur.'. Derrick Engineers. Crane Operator.'. Train Dispatchers, Switeh Tenders. Inter- locker Levermcn, Telegraph Operators. Student Ojierators and all other employes whose duties may involve the reading or display of signals in connection with the operation of train*. Marine Sen-ice--Captain'. Proper records of all examination? should be maintained. (To prevent substitution the applicant must sign his name before the examining sur geon. who will compare such signature with the previously signed applica tion made by the applicant before the employing officer. The data in the application form can also be made a check by questioning the applicant as to age, date of birth, !a-q occupation, etc.) Mate. Motor duties- Ch. Heat nun, to Si T-U> 2. Exiu projvr ai All cm yphih.'. All .i. iMiiiiinnl 3. Ph' jecUuu t 4. Em; dispatchc the railro re-examin an exam at Ica't or other* every yea 5. Befc his occupati Examining cer or his meats &r< 6. Env tend tow be dele 7. All lion or over 17.' 120 .'hall the abo' diastolic 8. Em which or hea An until be All have n'.< ( invnktre ui uhmi t t<r<j a .it tl- a). 21 i- (t-ncml >r r*vi*-w i -tin tl r.'M .`haiimao. rtloas, ace 19, ''ngm*'.'. ants for he rail* i before j'licrvnt* i.-nn of > p.VS \ H-:, .k> tu* tv M'h r:n- ('.u; uIro.-Miiz D-rr:>-k . tnU'rt| olher -ixnrd:* jif.iin-. Prevent sur- pplicain the :30t &9 vxiWW.iilHIUM ( % Proceedings o) Medical and Surgical Section 57 Mat**, i'll.,is Bridge Foremen, Dridgcima, Bridge Motorim-n. .ud L'nirim*or.<. Engineers and Firemen and others whose duties may involve navigation. Class ('ar and Engine Inspectors, .Vshpitmen, Air Brake and Steam Heat Inspectors Weighma.-ter*. Car Repairmen, Street Crossing Watch* men. l*olu:u I,ivuuouM\ l':in>lmen, Yard Clerks, Station Agents, Clerks to dt iti.iit .\i:*'nr>. Hurjra^*- .\<-urs Ticket Examiners, Cshers and T< l* ai.i ;i l!> 2. Examiii.itions and re-4-xaiii,nanon3 may be ordered at any time by proper authority MI rvi*v ftpli>y*s -houM have a laboratory biodd test for syphilis. All employes entering railroad service should have pre-employment examinations 3. Physical examinations dial) not be made immediately following sub * jection to unusual fatigue. 4. Employes engaged in ngine, train or signal service including train dispatchers and such others as may be designated from time to time by the railroad management, must pa-a a satisfactory physical examination or re-examination, including an examination of sight and hearing (and also au examination on colors if the employr-s are required to read signals) at least every two years or at more frequent intervals if required by Jaw or otherwise. It is recommended ilm .-iich employes should be re-examined every year from 30 to 63 and every six (6) months after 65. 3. Before an employe is permanently relieved from his regular duty or his occupation changed as a rc*uit of periodical examination made by the Examining Physinan. his cu-e ihail .V reviewed by the Chief Medical Offi cer or his representative wh>>-4- -hall bp final unless other arrange ments are made. 0. Employes im mluhtd m Hi;).- 1 who have physical defects that may lend toward -udd* a in*-apa. dy, diall !>.* examim-d at .-uch intervals .ts may !; delcnrumd by dus Hii.-f M. di. il I llljcef. 7. Alt employes mcimoiicd .n Hole 1, -who upon examination for promo tion or when periodically examined, am found to have a blood pressure of over 175 and li*> ihan 200 .sy.-iuljr, with a diastolic above 100 and below 120 .-hall be kept under ob.-erv-.uton. It is recommended that employes in the above classification with systolic Mood pressure of 200 or over or a diastolic of 120 or over be held out of service pending further investigation, and should be returned to service only with the approval of the properly designated Medical Officer. 8. Employes who have hern disabled by reason of accident or disease which predispates them to sudden incapacity, or whose sight, color sense or hearing may have thereby become affected, must pass a satisfactory examination before resuming duty. An employe with coronary occlusion should be removed from service until he presents satisfactory evidence of recovery without residual damage. All employes, except clerks, who have been injured off duty or who have been absent on account of sickness for over thirty (30) days should t j ( 1 l  i l ( 58 Auociaiion of American Railroad* be re-examined before resuming duty. The employe should be requested to furnish the railroad examiner with a satisfactory medical report from his attending doctor covering his disability. 9. Employes promoted to any of tlic positions covered by Rule 4 are required to undergo a physical examination, including sight and hearing; and in addition, such employes who by reason of their occupation are required to interpret color signals must also pass a satisfactory examination on colors. When the physical examination of an applicant for promotion gives evi dence of syphilis a coufinnuiory Mioraiory test shall be made. Finding1 should be handled as indicuP <). 10. Applicant* fur employment in position.- requiring examination of sight, color scn.M: and hearing, should fir.-! undergo this examination and in ca.se of failure, tin phy-i<:il * .\ai:..;<c,:oii nud not I*. continued. Em ployes undergoing jh noihr.J n.*4-x.::.jim:,toji> should be given comph'pphysical examination noinilh.-Ptrchny faihr*- of .-ighi, color :<:* or hearing 11. When r-ii.pl'*;.< - uxan.im d :'>< piuUfgiuii, pe:lud.caliy or by special examination, are found to have any disqualifying defect*, a full report shall be made to ofucor So whom iU examiner reports. 12. In order to prevent undue hard-hip to an employe in service, and recognizing the increased value of such employ*: because of his experience and familiarity with dulie*. to U: j rfwrmed, the cau>es for rejection a* hereinafter set forth, ahull not apply m rr-vMumnalion, except insofar a* the disabilities found on rt-exiiminMinn arc rurh ax to interfere with tV proper performance of hi* duliv*., or v.ii!> the >f*-ty of him*If or others. 13. The stamlaid- as recomuiciided a:< minimum but if any member ha in effect higher standards than shown herein, it is recommended that such higher standards be maintained. Rules Governing Examinations of Sight, Color Sense and Hearing The following rules and instruction*: apply to applicants for employment and to all employes who are required to undergo sight, color sense and hear ing examination? as outlined in preceding general rules. 1. All examination* of sight, color s- ns* and hearing shall be made by physicians. 2. Examinations must develop: fal Suiiicien! amlem-*- of vi.-lon fu ><* iharly the prerril*ed visibh signal.-. (b) Ability to d;.!ingu;.-h rolui* accumtely and promptly. (c) Ability to hear distinctly. 3. Employes who are defective in color perception must not be employed in positions that require them to use signals or to determine the color of signals. . 4. Employes who have defects in vision that can not be corrected with glasses to meet prescribed standard-, and employes who are defective in heariog must not l>c employed in po-ilions where their defects will prevent the efficient and safe performance of their duties. ?* ( 6. T **d 41 while vision Where of dist special one ps type t: must t Cm An c (for e% by the the eu produc Uftl test t\ eard\ and di If he vision, him to he can **eco (; desocn Mist on the satisfart denomu evption the I right aary the i torily. of the Proceedings of Medical and Surgical Section 59 5. Employes whose vision requires the use of glasses to meet the stand ard and whose duties necessitate the reading of signal indications must, while on duty. w ar .-u>d -da-.**-*. I'.mpJ'iyi * inquiring gliweu for distant vision must h:i\i* with '!> :u wlulv oil duty two p.urs of tIn; ri-uumti glasses. Where glrwrs arc n*quii<-d for hoth distant vision and reading, two pairs of distant ?p--:!achrs aud oq pair of reading glares or two pairs of bifocal .spectacles must 1m* earned. Where glasses arc necessary for reading only, one pair of gin*--'.* 'mv ivpe) will be satisfactory, but if of the nose glass type they !> a?: i'i;--d to tf;*' p-r.*on bvproper guard. The employe must l e t.xanun- d .v;:lt . a.*!i; ur '-t gbtvi ?. rioggles worn with corn live Un^s mu-t \ of ihe rigid type frame. An employe whose virion in one eye falls Mow the required standard (for example, loss of virion in one eye) -hail havea special examination by the company oculist and die management shall then determine whether the employe can bo provided with employment where his services will not produce an extra hazardous condition. ACUTENESS OP VISION Method of Tvjting. All visual examinations shall be made with standard test type. Place the candidate to he examined twenty feet from the test cards, cover one of his eves with a card, avoiding pressure on the eyeball, and direct hsm 10 read th>- *n c'riaiu line* as shown by the examiner. If he r?ad3 the letters on the fine marked twenty, it indicates normal vision. If he can not re id the letters on the line marked twenty, direct him to read 'he lines above :wnty -stvely until a lino is found which he can read. Record in fractions the acuteness of vision as determined, the numerator being 20 (the distance m feet at which the examinee is placed) and the ih-noiinnaiur th<- line r. id. of not mor>- 'J;.m i.n-c Jet.'<rs on die 20/20 line, two letters >n '}*<' 2<t ZD bne and <>ne Mt*r nn the 20/10 line will !e considered as tn-/j' lr.:y . ! ling. . iiri.n-r '. !: ,ng r.v - --2 nr --I, after the 4t*-n'nj.sia'.`ir. iL- r.niub.-rs of uri-M. In i-xamming for visual per- cepiion, the 'xirniner .-h-mld use every means 'o prevent applicants from memorizing :he letters. Th> may be done by varying the order in which the lines are lead, or by asking die applicants to read certain lines from right to left instead of from left to right. READING CARD TESTS Direct the candidate to read certain works, sentences or figures from the standard American Railway Association reading test card, with each eye separately, and record the smallest sizes of print read correctly at the ordi nary distance of from M to Id inches. The applicant should bo able to read the print in paragraph No. 3 of the standard card to paaa the test satisfac torily. Equipment. A simple apparatus which prevents memorizing of the letters of the cards and by its lighting arrangement more clearly simulates bright 60 Auociaiion of American Hailroadt daylight, thus permitting its use under al] circumstances, and which has ease of operation, together with a low cost, and arranged so that the cards are not soiled by handling, is desirable. Any generally accepted method of testing the acuteness of vision will be satisfactory. ACUTENESS OP VISION--REQUISITES Clot* A. Engincmcn, Firemen. Motormen, Mntormcn's Helpers. Conduc tor.*, Train Flagmen. Train H:igir:iK''mcn. Switchmen, Brakrmen, Train Porters uitcl nil otlter.. win* have any dnu> in ennneilinti with Hie opera tion of (rains. Entrance to Service Promotion Re-Examination of those in the service 20/20 in each eye tested separately, without glass es, and with binocular ingle vision. 20/20 in one eye and not less than 20/30 in the other, with or without glasses, and with binocular single vision. 20/30 in one eye and not less than 20/40 in (lie other, with or without glasses, and with binocular single vision. For near vision -- read print in paragraph No. 3 of AAR. Standard Read ing Card, without glasses. For near vision--rend print in paragraph No. 3 of AA.R. Standard Reading Card, with or without glasses. For mar vision--read print in paragraph No. 3 of AA R. Standard Reading Card, with or without glasses. If an employe in Class A. on examination for promotion or on re-examinatioo is found to have a vision of 20/70 or less in each eye, without glasses, even though hi* vision can he brought up to the standard above set forth, by glasses, he must be examined by an oculist designated by the company, for recommendation* n to whether hi* viion will interfere with the per formance of hi* duties or with the Kifr-tv of hiiii.v-H or other*. CIiisa Ji. Signal Repairmen. l.an.pmen ^Signal). Yardmaters. Carpenter* on line work. TIostlers. Station Baggagemen, Railroad Crossing Watchmen. Bridge Watchmen. Wreck Foremen. Track Foremen. Messenger whose duties involve danger from moving traina. Chauffeurs. Derrick Engineers. Crane Operators, Train Dispatchers, Switch Tenders, Interlocker Levermen. Telegraph Operators, Student Operators and all other employes whoae duties may involve the reading or display of signals in connection with the operation of train*. Marine Service--Captains, Mates, Pilots, Quart-cnna.** ters. Bridge Foremen. Rridgemen, Bridge Motormen and Engineers, Engi neers and Firemen. L.-'. i V 1 20/30 in or 20/40 jn tb glasses, anc vision. For near vigraph No. Rending C glam**. CZar* C. Heat In-ijio*tnen. Police to Station A graph Repair Eotr 20/30 is one 20/40 in otl glass*. For near tbu graph / 3 Reading J*-' glasses. AU appHean meet the Method of Ei The spjdira permit of a ] >ereen or a xtriin*-d, ibchi stand in a br>. Evidence* of ease* of the ey physical), defo emaciation, ru other tumoo, meat, such as of infections. ( which had ; the cards ision will . Conduc<i. Train iC upor;i- nation ' in ice eye and M/40 in *ith / 5, i* 'inith- n--read iph No. 'andard wiih or 'mm i: 11 * f-rth. tpany. e per* enters hmeo, whone neer*. rmeo. ?hose h the maaSngi- i Proceedings of Medical and Surgical Section I Re-Examination of those Entrance to Service in the service V 20/20 in one eye and not less than 20/10 iu one rye and not less than * 20/40 in the other, with or without 20/50 in the other, with or without glasses, and with binocular single gla.'rsea, and with binocular single vision. vision. For near vi-uon--rrad print in para* graph No. it. of A.A.R. .Standard Heading Card, with or without glasses. For cv;r vision--read print in para graph No. 4, of A.A.R. Standard Reading Card, with or without glasses. Class C. Car and Engine Inspector*. Axbpitmen, Air Brake and Steam Heat Inspector*, Wcighmasters, Car Repairmen, Street Crossing Watch men, Police l.ieuTenanfx, Patrolmen, Yard Clerks, Station Agents, Clerks to Station Agent*, Baggage Agents. Ticket Examiners, Ushers and Tele graph Repairmen. Re-Examination of those in & Entrance to Service t the Service 20/30 in one eye and not les9 than 20/40 in one eye and not less than 20/40 in other, with or without 20/50 in the other, with or without V glasses. glasses. For near vision--read print in para graph No. 3, of A.A.R. Standard Reading Card, with or without glrL-ses. For near vision--read print in para graph No. 5, of A.A.R. Standard Rividing Card, with or without g! AM * f->r injili> mint. not itu titioncd m Class A, B of C, must ;rir* f 'lie vi-u.il ropitrcUHnls jur a re-^xamination of Class C. PHYSICAL EXAMINATIONS Method of Examination. The applicant or employe id required to remove sufficient clothing to permit of a proper examination. >he examination to take place behind a x*ri*on or in private quarter*. All new employe* should be completely stripped, including .-hoes and .-ocks, at examination. The examiner is to stand in a bright light and present .-aicre.-odvoly front, bark and sides. Evidences of the following should be looked /or: Abnormalities or die* * eases of the eyes, ears, nose and mouth, retarded development (mental or physical), deformity or assymmetry of body or limbs, spinal curvatures, emaciation, cutaneous or other externa) disco**), glandular swellings or other tumors, nodes, varicosities, cicatrices, indications of medical treat ment, such as blister, stains, scarifications and scars from administration of injections. Evidences and effects of former injuries and operations should t \ I 62 Auociatitm of American Railroad* be soled. The ban da tad feet and the various joints of the body should be carefully examined to determine their functional efficiency. The chest should be examined by inspection, palpation, percussion and auscultation, both anteriorly and posteriorly, for tuberculosis and other lung, pleural, pericardial or mediastinal conditions, and valvular and other diseases of the heart. Check blood pressure and note heart action and respiration be fore and after exercise. The examiner should carefully inspect the abdomen and note abnormalities. While the patient is coughing strongly, be Bbould examine the umbilical, femora) and inguinal regions in order to determine the presence or absence of actual or potential heroiac. Any enlargement of the various canaN should U noted. lnsf>ccfion should be made of the gihif.'ili.i for u-mn.d .<;*. vuriroe* !*, orchitis, urethral discharge. and oih'-i nhiionij.d condition.' Th< huUot-ks should }' .`oj..-iraii il for the detection of hemorrhoids, prolapse.*-, figures and fx>? The applicant should U- thoroughly interrogated relative tr> his past medi cal hisiory. Th<te should lx maximum ami minimum bright and weight standards for new train and engine employes. Minimum and m.iMmmii blood preasure standards for new employes: It is recommended tha1 an applicant for railroad service should not exceed a maximum systolic Mood procure of 150 or a minimum systolic of 100, and a minimum diastolic blood pressure of 60 or a maximum diastoEc of 90. Recording of Physical State. Physical examination should be mvlc of all applicants for employment. The examination should be accurate and thorough, recording negative as well as positive findings. The extent of the examination depends on the standards defined for the various services. The report form should cover the examination for entrance into the service, promotion, return to service, and periodic examinations. Height Weight Hair Nationality Age Eyes Colored White Occupational History Former dust or othrr hazard? Physical State Appearance. Vaccination. Narcotic habitues should be disqualified. Special attention should be given to constitutional diseases including diabetes. Weight (Height) Compared with height and age. houid chest oral. * f i he* jmeo iould mine ul the 3. and i, pro- medi- taadards mpb otx- Of *v-, sdc of 90- ployment. Is on the .itld cover :u iervice. *it i> including Proceedings of Medical and Surgical Section IDEAL1' WEXOHT TABLE Based oo Maximum Longevity Ideal Weights for Men. Age* 26 and over. 63 Height Feet 5 S 5 5 5 5 5 $ S 5 6 6 6 6 Inches 2 3 4 5 6 7 8 ft 10 u 0 1 2 3 Weight in Pounds (As Ordinarily Dri-sscd) (rmtur M.-.litliu Frame 116-125 U9-128 122-132 126-136 129-1,19 133-143 136-147 110-151 144-155 148-159 152-164 157-169 183-175 168-ISO 121-133 127-136 130-140 134-144 137-147 141-151 145-156 149-IGO 153-161 157-168 161-173 166-178 171-184 176-189 f^rge Frame 131-142 133-144 137-149 141-153 145-157 149-162 153-166 157-170 161-175 165-180 169-185 174-190 179-196 184-202 (Above Table irora Metropolitan Life Insurance Co.) CAUSES TOR REJECTION OF APPLICANTS FOB EMPLOYMENT General Medical Conditions l. Dtabrdc.-j MfllifU.s. `2. Seven? iii.iliinlrilioii. 3. Pellagra. 4. Avil.'unmiws amt oUu-r *<-v>-r>? smsrili.>n;il .onditioos. 5. Osteitis fibrosa <?y>uc.\. 6. Tetany. 7. Addison's disease. 6. Froeblich's syndrome. 9. Siramond'a disease. 10. Hyperthyroidism. 11. General debility. 12. Combination of three or more chronic condition*, which individu ally are not disqualifying, hut which when together cause general debility, anemia, circulatory and/or menial infirmity. 13. Acute systemic diseases, such as infectious fevers. 14. Marked overweight or underweight, taking into consideration height and age. 15. Generalized or localised lymphadenitis. i \ l i 64 AfocioJum of American Hnilroad'* The Eyc--Loss' of eye, total Joes of sight of either eye, trachoma, ectro pion, opacities of the cornea, if covering part of a moderately dilated pupil, strabismus of low visual acuity, pronounced exophthalmos, conical cornea, cataract, loss of crystalline lcn3, pronounced entropion, pronounced dis eases of the lachrymal apparatus, eymblepharon, tumors, abscess of the orbit, nystagmus, pronounced asthenopia, glaucoma, color blindness (in certain occupations), diplopia and loss of pupilary reflexes to light, gun barrel vision, hemianopsia or loss of depth perception. --Color Vision-- A ti-.-t lor the ijrln-tion of rolui ih-fir.l.' should be one which can be carried out a- rapidly as pns-d.li wiili maximum efficiency. Th- Holmgnn wor-h-d* or any Muinl.ird modification have historically been very n-habh. Si-viral lament |e>i> have* been devised which are also reliable. The l^biharu (color plate! which was modeled after the Siilling- i. rather accural*. There are several modifi cation* of thi> 11.~t bm th-- color.- an- apt to vary with the printing of the color plate*. Color plate tent* are favored; lantern testa also are reliable. Field tests arc not reliable and therefore arc not recommended. The Ears--Dcafue.-s of one or t*oih cure, all catarrhal and purulent forma of acute and chronic otitb media. disuse of the mastoid celt*, and moder ate i-ontinued dizziness and/or vertigo. --Aural Test-- Method, Place the candidate at a distance of 20 feet with one ear toward? the examiner, plugging the opposite ear with cotton; then have him repeat aloud words or numbers spoken in a conversational one by the examiner and record the distance at which they can be repeated correctly. Have him turn the other ear toward the examiner and repeat the test. In doubtful cases, the use of the audiometer is recommended. Qualifications. Candidates for employment should not be accepted unless, able to hear ordinary conversation, with each ear separately, the full dUiuncc of 20 feci. Employes io tiaiu and engine service should not be permitted to work with the- use of a hearing aid. Mo employe engaged in a hazard ous occupation should be jn-rmittrd to wear a hearing aid. Th( Ktm--Any sorioti* pathology involving the nose. The Mouth--of ]art or whole of either maxilla, ununited fractures, ankylosis, deformity of either jaw interfering with mastication or speech, such as cleft palate or hare lip, marked pyorrhea or gingivitis, focal ab scesses; markedly disexed teeth, hypertrophy or atrophy of the tongue, chronic ulcerations, leuroplakia. fissures or perforations of the hard palate (if marked), salivary fibula. Im-rlropbv of the tonsils sufficient to inter fere with respiration and when tonsils are the scat of septic foci, malignant growths of buccal cavity, and loss of enough of the tongue to cause aphonia and inability to communicate vocally satisfactorily. ric ex: be WT an Cs. i ( 6 si* jt 1 1 I 1 1 1 1 1 /1 \I 2 2 2 I low mo du H*V- di-: inu proad)' I tioc i two ilk* i r tuo: brew . i rrl I ( Vrix i cdiiigs of Mi dical tind Sv'jical Section 65 The Head--Abnormally large head with deformity (hydrocephalus and rickets), depression from ir.i>-iirc of -kulf, trephine openings, caries and exfoliation of hone, injury of crania! nerve*. ozena. The Seek--Toxic goiter (simple iroifrr without 'ymptoms, if small, may he accepted), tuberculous adenitis, trachea!, thyro-gio'-aal or cervical fistula*, wry neck, chronic laryngitis or di.-euso of the larynx producing aphonia, and strieture or div.rneiiluui >( .te-nphazus. Cardio-vascular System 1. Dcrofiipen.'tftion. 2. bacterial i nd* irdun--;*<; ,r chronic. 3. Syncojvcs--recurring. 4. Mitral stenosis--with derompi.n.'atory signs. 5. Coronary infarction. 6. Angina, all stain's. 7. Myocardial fibroses with -ymptoms. 8. Systolic and diastolic murmurs accompanied by enlargements with signs aa shown in No. 1. 9. Aortic in.suHicic/icy--with or without low diastolic pressure. It). Aneurysm of aorta. 11. Coronary insuifieieuey with symptoms. 12. IVnrnrditis and p.-meaidi:;- with seipielae. 13. Heart block. 14. Morg,itzni-Ad:im-Soik*- Syndrom**, 15. Auricular fibrillation. 16. Paroxysmal tachycardia. 17. Artena-derosis. 18. Impairment of circulation of . .vireuiitic*. 19. Intermittent rl.iudioation. 20. Exertional pain of '`\fremiri'-<.. 21. Thromiioatigisi.'i obliterans and K.tynaud's Disease. 22. f`arotid-inti> -vri- opr.-. t'/i/u f mi'l I."Ui r /.*./> imi'i - Aif* ions ri,ii<in'iii m both the pj>er and lower cxfri-mni* chronic i!>* imi.ui-in, *d.r>>n;'- d*-i a.-e. of the joints or movable cartilage, aopiin-d or romp uii.il deiuruudrs. ..u*h as old or irre ducible dislocations or false joints, malignancy or stu`s*ectcd malignancy, severe sprain, marked relaxation of the ligaments or capsules of joints, dislocations, fistula connected with joints or any part of bone*. effusions into the joints, badly united or uounited fractures, rickets, caries, necrosis, pronounced exewtoses, atrophy or paralysis of a limb; extensive deep or adherent cicatrices, contraction or permanent retraction of a limb or por tion thereof, loss of a limb or portion thereof, toss of thumb or loss of two fingers on one hand. iaiieo-c veins (if pronounced), dub foot, chronic ulcers and disabling uctpiiital flat feet. The Chc*t--Caries or necrosis of riba, unresolved pneumonia, or pLeumonitis, marked emphysema, chronic pleurisy, pleural effusions, chronic bronchitis, bronchiectasis, tuberculosis, asthma, repeated pulmonary hem orrhage or marked lo* of respiratory rapacity, organic diseases of the l I<a 66 Auociation of American Railroad* heart or large arteries, protracted functional derangement, of the heart, and abnormal variations of the blood pressure. The Abdomen--All chronic inflammations of the gastrointestinal tract, gastric resection, diseases of the liver and spleen, ascites, pronounced hem orrhoids, prolapsus ani, fistula in ano, fissures of anus, hernia, actual or potential, in all situations (exceptions: clerks and others not engaged in laborious work, who have a single reducible hernia supported by a wellfitting truss). The Gcnih^l'tinary Organs--Gonorrhea, syphilis and venereal sores, strichirr of Ihe urethra. undesccnded testicle. except when within the ftlxlomen. chrome di*e:iw-v (,f the te*tieh- or epididymitis, hydrocele of the tunic and cord, unit.-* the h.vdroecje is small and non-progressive, varicocele with symptoms, disabling malformation* or diseases of the genitalia or bladder, all organic of the kidney.*. and la*.-' of one kidney. 'Applicant* with varieoeeh may lx- accepted when it is not accompanied by atrophy of the testes, pain or an evident neurotic state. The Spin, --Caries, spina bifida, lumbar abscess, fracture and dislocation of the vertebrae, angular curvatures (unless slight and lateral only), includ ing gibbosity of the anterior and posterior part of the thorax, moderate or severe symptomatic or asymtomatic arthritis of the spine, and pro truded intervertebral di>e operated or utiopenitcd. 77*/ Skin--(`hionic. malignant, contagion* or parasitic disease? of the skin. Deep ami adherent rirnt rices; chronic ulcers and vermin. Mental and Mural /nfimitics--Any mental infirmity, epilepsy and epileptic equivalent, diseases of the cerehro-spinal system, chorea, and all forma of paralysis, tabes dorsalis or persistent neuralgias, and chronic alcoholism and habitual use of narcotics. The Reflexes--Abnormal reflexes taken in conjunction with history of physical findings indicating possibility of serious disease. Laboratory Blood--It i recommended that a routine blood test for syphilis be taken on all applicants for railroad employment. Laboratory Vrine--It is recommended that a routine urinalysis be lr don*- on all applicant* for defectum of albumin anil sugar, FOR PROMOTION AND RE-EXAMINATION OF THOSE IN SERVICE The rr.'illi* of ; physical <-\atiiiual ion may bring out certain dis*pia!i/y* ing findings, hut keep in mind first, tin- duties that the employe must jicrform and secondly, the ability of the employe to perform that duty promptly and satisfactorily so that loss of life and property will not result. EXAMINATION OF RESTAURANT AND RESTAURANT CAB APPLICANTS AND EMPLOYES Applicants concerned with the preparation and handling of fomlatulTa or dming equipment shall be examined Iwfori? entering FOrvice. f Btr iu* th* t ab. ata be fit I f A we! { pos. whi to : the 1 son iHl a> Oil . post rt, and ! tract, 1 bctn.ual or gvd in i wtU- stric* lomea. ic and 2 with ladder, ponied cation ncL* dera. pro- if the Uoptic ts of mli-in ,ry <>? i -..f '!* I* VICE alitymust duty rsult. Proceedings of Medical and Surgical Section 67 Employes concerned with the preparation and handling of foodstuffs or dining equipment shall bo rc-cxamincd, the periods uot to exceed six months, which should include examination of the lungs, skin, mouth and genitalia. Employes found to have a communicable disease when examined shall immediately he relieved from duty and not permitted to resume duty until all danger of communicability has disappeared. Food handlers with sores. >kin eruptions or di.d'muring endinons mi expuo-d part.* should be relieved from duty until condition w corrected. Employes oiT duty account of illne.-s six days or longer should be re* examined before resuming duty. GENERAL Many factors enter into the ultimate decision as to the earuJidatc'j* St* Oca* for service. Where all other physical factors are uortual, it is not justifiable to reject nn applicant unless there arc marked variations from the normal. When an applicant for employment has none of the disqualifying defects above mentioned, but whose genera) condition (mental or physical) it sub standard from any cause and whose ctliviency is thereby impaired, he should be rejected. In all doubtful ca.-\< the Company diouM be given the bene* fit by the Examiner. or if ho <!c.-ir. < tin- mattor may be referred to tht office i of the Chief Medical OtTicor. Applicants should be vaccinated at the time of examination unless a well-pitted .scar is present, especially if smallpox is epidemic or sporadic. (Them followed a geticiul di-cu-.-imi of the various jmnion* yf this pro* jio'i d revision and a number of .iicg* -lions wore made as to revision* which Dr. Ih-mictt and Chairman Metz advised would lx? considered prior to :iuv tidal pubtn V ,*.;i >.i 'hi- A* much of :}. . u t j. :iie-r< t-ord, it i< not included here in d.tail.) Tm: Chasumvn. Di-mh-m'-u. .is 1 mentioned this morning, we have nm members of the l'o-t Office Department here to li-u-n to >nr report oft first-aid. tVc are mn.-t pleas'd to hue them with us, and before going any further with this subject, 1 no;v call mi Dr. Uruiiam to give his report on first aid equipment. Db. GbaKam : Mr. Chairman and Gentlemen, the following is the pro* posed revision of Circular No. MiS-217 relating to first aid equipment: -'if'- * A, -t 68 Auroduiutn ttf Aiucrifjtn lOiilrotuli 5 *f *i (PROPOSED) Circular Ko. MiS ---------(Supemdiag Cir. K. M6S 21? dated May 31, 1929) ASSOCIATION OF AMERICAN RAILROADS OPERATIONS AND MAINTENANCE DEPARTMENT OPERATING--TRANSPORTATION DIVI8ION A/; V 1 S COTDt her Ri The meat, known Ant pftr MEDICAL AND 8UKOICAL SECTION 59 Vun liurin Street. Chii-ago 5. IDinoi- J. JJ. AiMt-ori. Vje-I're*u} i,i (>;< -itiA M.ti:;li"i- I * ; Ofltccra of Section Ir.. A. Jt. M/TT, ('Iiuirm.nii Jtl. , Wl-f 'h.":i iu:u. II. >. Di.HMt ii'T. Srr< l.irv accomj plflrr* i the fits ll wool MWglr.d SurgM-al kvunir Recommended Standard Practice in First Aid Training and Surgeon's Report Forms A* n w~ <J by Jit. l<ili rt M f Paiialn. J>ir<.>i. J> ; :tu t.: .i >;iijt:.iiion anti Surgery Tin- J'uIJin.u) Company pCM'tl I . titsih .12) Pa*t * of mcml j and eijs mgs. In find aid Ttt t>ie MrsiuKK.-: January 2G, the oja-n i We m the folhv. In 16.0 M J,- : S..!);; .-. nr.!: <j Circular MtV.S-51, whim im hi-h.-d Jit eyu.;:.. :, ji -i S aielartJ J`iar:w a.* In First Aiil Training and Fijuiptuejii. us Vr'-l a- Str.f, > Kpoil Form.*- covering: (:) Company Sitii'tiiif Fitrt Ifi jKiil to Chief of Surgical Service. 0*> Compart; Supplementary Weekly Report. (v) Com;,any S;.:-;. nr/.* Final Report. (d) Report to C.'iiit of Surgical Service by Employing Officer advising of the Etepioyr'j. return to work. % American metal or I wit1 ig, 1 *1. . 4ij- 6- That portion oi the jjertiuti's re run.memhtlioDa relating to First Aid Treatment, Equipnurn. etc.. wa* revised in 193S, under the title of "Firs: Aid Instruction* Rr-iiroad 1\>pImv muI wu> distribut'd to Mcinlr: Itii.ul- wi'ii 0;e:;: ,:ic-I;aj.-j ielaiim Di'i-am Circular No. 11. Cio-uln: S<> .i i--a< ! J.v lie Medieul and Surgietd Section under dnf< of May dl. Unit* . illu-:r;it,<ii- of Company Surgeon% reputt futtu*. a* pn v ,..:i.iv r> -iiiuiiu pdi d. and railing attention to .some (leve)opimn'*- .*inei He original report l.v tJic Section in 162a. Tbe pau of 12 ply, . jd.t'MU*' j*. sWiH W Li Tl**- Kiu After tlv. |ruli *tiuu. laminatiiij: Attention FIRST AID INSTRUCTIONS of the type in location.* The booklet covering "First Aid Instructions for Railroad Employes'* has era! small, a recently been revised by a Committee of the Medical and Surgical Section, puncture w< after submitting the problem* to the head.* of Medical Departments of applying lar, Member Koads. Thi* revision (January 1951) was approved by the Com* mittee of Direction, Medical and Surgical Section, and by the General We do no I standard pat I I Procctdin$s o) Moiicul and Surgical Section 6`J Cow rr.it'tc. *); r'i;it ing-Tr.msporralioti Division, for distribution to Mom* i.T Railroads. FIRST AID EQUIPMENT Si-! .mi has tlie |ni!.i !a problems of First Aid Equip* men1.. and previous 'iwi-jfir.-ilioii* mad*' for n -tandxrd first aid packet known of Ahothmii ll.ulroad's First Aid Picket. It is j: v'i >i >> Tnolov t r.un.il fir-' ;! r < i a prnfi\--io:i.d iJi-ul:int to r Ji fi.oii >r < a* u'.wuh *-*. Ui^UtWi at tin* nunr-fittis -mall .High! ! oji iarc occasions; therefore, iic hr.d ,:;d i-quipm* ji: -ir.int tin limited to :!r> ability of uo'-rained help. I: would i-v tmroii-oii iMc :o jii v drugs to be prescribed by laytuen, or -surgical jupplies that could not be used by the same character of help. Surgical i.':---inga that .ue kepi io ordinary commercial packages may he-ome < riKaminuioil r| wasted. To overcome this difficulty a first aid ;< -ut.iiiiiiig only -I'-iile pads .so that they may lie 'asiiv ad quickly applied until lint patient can lie .-atm by a doctor. Past experience with specially prepare*! dressings made to special order of members of the railroad industry has shown that this is a troublesome and expensive means of obtaining and maintaining proper first aid dress ings. In vj'-w of tliH. it >< recommend* d that dressings used in railroad first .ud p.ukcts b*- of - mdard form and packaging and obtainable on the open maiket. We recommend ind.u-d first aid . a -ket be made according to the fallowing .-pecifii-ations. .ad :ha* if L>t known as the Arscciation of American K.inroad's First Aid Picket. The container shaU be a cardboard, metal or pla.-tic bo.v. approximately t'a" \ J'-i"x l" 'inSide measurements, with Is.ngM *-;p or -id* . Tit*' i-ors"'if * of lie- !a -h ill !>. , I- ptic jiuu/*- , <ii> 2" x l" im 'U..ul wounds; A id- :r ; I!" :*; und-; J 2" \ .1 yd-. !!. r- -*-d .ViImIi i tip-; i-li"x;r -m.-tii. .'ady-iou-e adhesive gauze strips. Trv* gauze pad -h dl i* of grad- 2rt \ 12 :: di or finer; 2* -ize pa*! vf 12 ply, .md 'iii- ii~ -ize o.id of lb ply. Kadi pad shall be in an individual gloine paj-r-r envelop*' . :o.-ed and .-ubji' U-d *o sterilization. Envelope .-hail lx* labeled as to cordon*.*. The bandage diall ! of im>h 2d x 21 cause. *>r liner. After the packet is filled it may be enclosed in a ghussine wrapper for protection. However, partial use of contents can be made without conLaminating th* other enclosed dressings. Atjcntion i.s called to the fact that there is no objection to modification of the type of container which may be dc-ired by individual railroads, and in location* where boxes arc subject to frequent use, the addition of sev eral -mall, .sterile ready-to-use adhesive strips for minor cuts, abrasions, and puncture wounds is suggested. These adhesive strips may also be uwtd in applying huger dressings. Wc do not recommend the Esmarch triangular bandage as a part of this standard packet, since the pads we iiave described may be used to apply 70 Association of American linilrwul* pressure- locally to bleeding points as advocated in the A-AJl. Manual of First Aid Instructions. Handkerchiefs, a bell or a stout piece of doth may., be uecd in rare instances where a tourniquet may be indicated or a aling is needed. We also recommend the U. S. Army Stretcher as a part of equipment of baggage cars or combination baggage cars. This stretcher will also serve as a cot. If blankets, pillow*, etc., arc needed for serious illness in connec tion with the cot, or iu fracture cases, they should be obtained at the time of accident; otherwise with long keeping they may inevitably become deteriorated and tw\Ve believe this equipment in the hands of Joy- men i> ihe um.-t pi.u iir.i! :iu>l i iiiufoi I;il*h Hi* :ld of tr;in>7*rlmg all ri- ofou> c;i.m ' Mtkij*-" oi iiijiuy. It is r< i iiiorii' U'h d i)> u ihi Fum Aid J'.-n-hr I Ih Io< ati-d u.- follow.': 1 Ti.*.n >' i \ i' Ii- < 11c i and t u V:i"> jrin i Tr.i.ii' I pu' W< l < h in m u h<-'. cnr>, aiul rligiue. Fri.ghl Ti.uio L* p-nl.il m -:tl.***- and I m rtitnti'*. 'I SmiU rfhop . iJ-.-n.d Jluu-' , ):idp- ai. l Building Foii-c.-, S*i-clu>n CiauR.-, Surveying Turlies, LiU'incn, Hallway Stations, etc. Fu.'i aid pui-fci J.--- 1 to 10 dcpriidiug on nmuhi r of employe*. 3. Larger Shop.', Office Building-: and Terminal points. First aid station fully equipped and in charge of a surgeon or trained nurse. A.--First aid Box with emerge ney .vuppliey may be provided a* decimd uecis.'ary in the judgment of tin Chief Surgeon of the Railroad ior eeitain jvd.ifed or unusual location*. On behalf of the Committee of Direction. Hespertfully, H. S. Dewhokst, Secretary'. Dk. Gbaham: We have di>cu$sed this first aid equipment with several of the large companies and we have here one type of kit which has been considered by the Committee. This *ku was put up by one of ibe large manufacturers. For those roads who desire the addition of the triangular bandage, you can put the triangular hawing'- in the same tyi*e of kit. A box of this type with ib;i <ip:i]-m<n! mu ! puurh:i-d for approximately 40 to 50 cent.-, we midi r>iaiid. W ith tin ini.ngulai bandage added it will, of rmir.-r, inm-aM- lh<- *<*l Ui havi h>-ii- ;t- >un- f you have sia-ii, U*old carJboard box wt<:*h jig.iiti will curry the Jir^v aid equipment, put in a glasseen cmlo.'Un which can in* carried around iu the pocket. Another large concern which hn.- rejirc-.M-ntatix e.s here- today, has changed their methods of muoufaciuring of supplies in a certain extent, and the old gauze bandage concurs* is no longer readily available. When available, it is only as a 'special order. Thc Chaibman: Thank you Dr. Graham. Before we put this ojcn for any general di-cusdon, I aru going to ask Mr. C. F. Hank, who is acting Chairman of the Committee of Hailway Mail Transportation, in Chicago, and who is, incidentally, also connected 3* I i { ; i ' { j j i j .I with the him and Ms. R. Commits tee reprer dealing w The ru' concern n and the ii Only re ' mo n> o- ihxw* m t nrgauiiatK ehsrtric hi fjw-cifiroti 1*>I U1 for a hr.-i to have lx Aerordii meat in n have k*t U and allow the Poet 0 t have snttsfartior but T am what you railroa-* > need^ We'sec ing $7 wl that, and tho*e rema; would like talk about he has to we can gd Post Office mouthing Mk. A. 1 of Transjx like t* v*> ptare benin* hit and aow< furnishing be furnished live to find Mr. Land in the prep* the aohjcct Manual of Joth may or a ding 'pnpmmt il>< ,x rvr .n cuiiaa(l ttio time .y Leonine iJj of lay* ag all seri es: vnd engine. 3, Section oa. r tea ovid'.d xi :oa of the [ LIlsT, dietary. i ...vital !s.i largo it i.mgulur ..i Kit. A oxituaUdy 1 it dl, nvii, the , put in a i changed . and the available, ig to a&k Railway onn< * Proceedings oj Medical and Surgical Section 71 * with the Milwaukee Railroad, to pfo>. ut their prnhlems aa have come to him and he hits dUrti.s^ed them with me. Mr. Rank! Mb. Rank: Dr. Metz nd (linflemm: Von have already identified the Committee on Railway .Mail Tran.(orlaLn.ii which briidly ia llic commit' tee representing all r:tdraU n>ide from some of lhe short lines in matters dealing with mad Iralfic, The rules oi il.. I'o.-.I, Uifi.-e Depariim uL ;u they apply to the railroads concern mutual prulilems of *ervico, tram operation, mail ear construction and tl>e interior 'i\l.re. Only rrcendy wo revised tin* q>a-ili.-nti<itn for the construction of mail cars so as lo fit more nearly our present conditions such as having wider doors in the cars, and meeting some of the demands of the postal clerks' organization with respect to closed-in toilets, electric water coolers and electric hot plate3, improved lighting and a number of other matters. Those specifications were adopted effective September 1,1949. Last fall the Post Office Department made a request upon the railroads for a first aid kit and a few of us thought that perhaps the matter ought to have been considered also by your group here. Accordingly, I wrote Mr. VanHoru who represents the Post Office Depart* moot in matters dealing with mail car construction and fixtures, and wc have let the matter rost until your committee could meet here as of today and allow Mr. Landry, who is here also and who is Director of Safety for the Post Olfieo Department, to Urh Uy pn--i-nt ih.-ir side of tL I have no i.h-.-i lini wc ;nc going i* di-j-ose of `his ipiestion to the mutual siii.-faction of the railroads and the Po*t <>ffiee Department here today, but I am satisfied that Mr. Landry will give very careful consideration to what you may adopt for locomotives, cabooses, baggage cars and other railroad equj\<cn'nt. .-hops and so forth. ,utd then try and coordinate their rmeds with what wc -pi.-i/v on the mln.-id. Wo re on n "d -and f *av "w.", Ji >:hot.N -for nur cnmrmlli-i* -`l`*nd- ing $7 when we might get hy with $2. I think we are all ronscimrs of that, uid .Mr f. m-liv vmp(h> n- :;, >\ Mr. VmH>n. and wuh tin.-- im:nk^. 1 diink 1 ir.ivr :n.Jn-*` | ..i,r p-..i*-nv Inn*. I)r. M<-?z. t would like to h ive Mr. /. mdrv c,mmr-n* m.I p.-.Lnbly w* .->n jn-r hriefiv talk if.out i> -* fir -i. `he Po-l tnij.-e | < p'ir:;m nl is *.invrn*-d l*--:tiw he has to make a t:W train '<* X. w York, and then subaeqijently, may!** we can get together and adopt M.rnething that will be satisfactory to the Post Office Department and my own ;M-on:d hope and wih is it may in* sonu-lhing yon in.-n will adopt h> n- for other railroad purposes. I' M. A. I.. Van Ib-uN iSup.rint.d-nt of Vehicle Design Section, Bureau of Transportation. U. S. Post Office Depart mi-ot): Gentlemen, I would {*. hke to say that the question of first aid kits was brought up in th first place because >oine nf ib*- radro.-i.L-! were furnishing one kind of first aid kit and some others wi re furnishing .-mother kind, and still others were not furnishing any at all. In order that similar containers and materials might be furnished by all railroad companies our letter of October 24, 1950, rein* tive to first aid equipment was issued. Mr- Landry, Safety Director, Post Office Department, worked with us in the preparation of those specifications and as he is more familiar with the subject we will hear from him at this time. 3*2SBESa iV-* T-.-T 72 Association of American Railroads Mb. Edward B. Lasdry (Safety Director, U. S. Post Office Department): Dr. Meta and Gentlemen: 1 consider it a privilege to be able to come before you men and tell you something of the problem that wc had with respect to first aid kits and what led to our thinking in developing the specifications which the Department issued last October. First of all I want to tell you that wc do not have a Chief Medical Offi cer in the Post Office Department who quite properly would have under taken the solution of such a problem. In the absence of such a professional man that task fell upon the Safety Director of the Post Office Department. I can aientre you immediately that I did not attempt to solve this medical problem alone A'-i-fatnc fintu \.itn>M- medical sources was obtained. Mr V.ui ili.in h:i- until .i>< d, It.;- pHrliti in \\a- jnripitali d by two fac tor.-. Ow-i ii pi-iimt til tutu- iiiiiin icii- cnmplainU have Jk-cii received from our railway mad i-h rk* that they Mile v had little Or no fit>t aid equii>- meiit in tin railway mad eat*, m tlm* iti swim- instance*. they had ample. \\\- found a* we >tamd tn look it.'.* the probh m that apparently their rompi.iiiii* i- lu-nl.i-d ii. * :m-i w>- found a wide variety of firs-t aid kit* l*i->ia ivhiI and suppled ,n ,h railroad mail ear.*. 1 j-rcrive ftotn your Chairman's comments that you arc giving consideration to setting up a standard in that part of vour operations which concerns the railroad directly. I do not tit' an to prolong mv di>rn>ion hut probably some oi you gentler men have s-n these kit.- a heady. (Showing several first aid kitv) It hKp(K.ii' thi* kit (hotdmg up exhibit) does nov have its content* within (he kit roniainet. htit it con-i-inl of so-called unit packages. In this in stance there mu two s-HM-l* bandage romprvs'* ', n 4-incb bandage com press, fom 2-;nef, g.itizi b.ind-.g*-, a 22-inch tourniquet, and 6 handitaf'ci. Hen- is atv.tlur kit (holding up exhibit) supplied by another road hav ing quite a differ* rd > t of contents. \V<- have some adhesive tape, sterile gauze pail*, ammonia mhahudK. tincture of mcrthiolate, handy adhesive gauze pads, and n (oiirni'iuet. Still another hi! (holding up exhibit) consists of two packaged items which contain sictili gauze pads, triangular bandage, 2 by 5-yard gauze bandage and some safety pins. The fourth exhibit I want to show you is much more elaborate. Not only is (here an instruction book, but here are some items of tie- contents-. I will just drop them out on the table in front of yon---.-i-j.-wor.-, ymd.* of gauze, tourniquet, an antiseptic, some eot- tnii. a*..i'd <,[ tape. mow bandage, burn outlmml and iuiiiiIh i ni nih.-r iii tn- tvldi i. I >].- II not take time to mention. TI.I J.u of atioi|i i uho.id uli.i (. | do tint have, con-i-ted of a -mall votioii,-. pad oi .d.-o:i.: g;n;z. , nb-ojheut cotton. one-onine of jnditi< . 12 Hand-Aid-. a yatd* ot .-iiii-'w plastei and : -imdl jar of bum oint ment. (Jeoilctm-u. i do not think 1 could be any more emphatic in displaying to you the lack of uniformity that prevails and the reason which motivated (fic Po-t Office Department to attempt to effect some standardization of the fir-t aid kit.- u-rd in the railway jmkI office cars. A little mmc by way of background In-cause 1 mx* in what I am about to tell you a difference in plidusopliv, from what Dr. Graham has said in the matter of first aid instruction or training. ttmeot): to come hid with ping the ical Olfir limi- fj'.wdou il .- ::a ip :n. .Old. '.WO f,1C- .r.fl irotu 1 equip.'ople. ily their aid kits ive from tting up rail?'-*-1. " gen' ..i within liliS IQ* .ge corniitapcs. ud hav* *, sterile adhesive d items d /-!>./ v y. .i| ... /Vor* i 'iiittfj of McdU nl and Surgical Section 73 Iq April of l1.>48 we launched in the Post Office Department a first aid training program for mir railway mail clerks. This program was nation wide, throughout she po-tal service. The .slumlord Americas Rod Cross first aid training course was adopted. The program was jointly sponsored by the National Fo-ta! Tiamportalion Association and the Pt*t Office Depart f ment. Our railway mail clerks wire advised of the first aid training pro i gram. They have puriicipatrd in the program on their own time. A.s I recall, ihc p;*-gri-s np.ut of April 1050 revealed that we have trained, .md Am ri> an Red Cross standard fir*t aid certificates have ln-en i-.ij. t<i :.ij<jO r.uiw-iv mail cl>rk>. Our objective, which wc have not leached t.< v l. ln\i' il. I* i-l -.lie cl.-ik in ach car jn.ihfi-d and trained in tlie Aim i i'-.tn Red Cro.-s sUndard first aid course. That w-i* 'in- b i- kgia.und which pieeedi>t| the next step--the develop ment of a -lamlaid .-p.'cifu:utiQ for first aid kits. Our thinking wad simply this, vve did not feel that wo should xsk the railroads for a stand 4. > ard first aid kit unless we had qualified people who knew how to handle the contents of ihc kit and who could administer first aid treatment in %i accordance with presenlred and recognized procedures. Our initial plan, I X therefore, was to .-tart a training program for our personnel and then to provide them with standard equipment, in which they would have available i everything needed for the administration of first aid. Let ino t- ll you ibout our injury problem which I think has a bearing upon the .'<! c1 ion of ; lie- items that went into the first aid kit. Largely. i:e troubl'd w:ih . >n'u-ioiH. ibri-i''iis, laivratinns and foreign bodies in i he eye. !.*. us diM.1)-.- .: ni.-yi-r of foieiun bodies in the ryes first. The Clerks "serving local-.'* >!<ai is. those rhat make the dispatches and the catches at the no.-top *: i:tons (this is done with the door open) are subject to foreign bodi'-s in :} eye. 'Die ileiks who arc working in the interior of ihe ear are bk. .- -ubp-et i.i dust md dirt ihul is whipped up when a i a: door ; ii \V- have a la! go pen i iilagc of eye injuries arising fn>m liiut -iiiree \ppro\imaio|y 11U per cent of our total accident problem III Mil- l.ll'.. H s, I.I 'I'.i. e I'l 'loin Vi- IIipillc* V*'1V W* 'VlII l'i ** J... e ullr ..............f .III. ..I |.,i< ..in bode.-, ill `III: eye |,y -Iqijllvmg dirk* serving !,. ron-top >ia>; tis aji.i pli.-tic <.-> protectors, also known as goggle*, ibra, .- r. f :hmk i:af ;i would be extremely diliicult, if not impractical. !o ain-mpt io ha . c all of the clerks working in The cars to wear eye protection all the time. You might !.* Junker intei.*t..| to know that in the .-^lection of items to mchidt: in itii* -p eification fur ihe It.l'.O. First Aid Kit, we wens guided largely by the prevailing federal specification oa first aid kite. I have communicated with the Council on Pharmacy and Chemistry of the American Nbdical Association since this particular problem came up. fn some points the Council is m substantial agreement with the com ments that you pissed along to us, Mr Rank. These objections concerned the use of tannic acid ointment for bums and boric acid ointment for the eyes that were included in the knit. Mr. Chairman, I do not know whether there is anything further I can add by way of history and information that might be helpful to the group here in evaluating what wc have presented. 74 AtMinium of A nuricun liadrmul* I will be happy to make myself available for such question* aa may be asked of roe. The Chaisman: We might first ask what you think of the kit Dr. Graham has presented as what the railroads have found practical after some thirty years of experimentation and working with this where we arc dealing with railroad meu all the time. Mk. Landhy: Doctor. I am humble in your presence here, when I say that 1 am sure that wia-n a group of professional men such as yourselves have given such lou^ .-tudy to a particular problem you undoubtedly have arrived ;t a >a*.'h. ->lut:>.n t<. tin pi!>M-m. It would 1* prcsumpluoii' fl ir- to .-ay iltlh , nl ) \ . Jh>i\i \ i. j<. ; nut tin to m.-iki- ibis point by refer* ete > |o |)i. (o.i]>.oo .-. .-t:it< Jii'-nl on In.-1 atd Irmmug { think lh>- rujlruad* and the J\t Ollu- In parlnx nt hu\<_ u bade difference in philosophy on fir*t aid. We fee! j<p!. *i.,.tt)d U tratmd in fir.-i aid 50 thal they will lx- compel t-nr to mlmmi.'ii r m.-i aid tvii*-n a man i hurt un the job, th'-n til ne !.< al Itiiil.m.i*. { tni.pitl It.i pi.Jjrv of the railroad- t' to haw li,. man .-* h inol. ai ;Kin:ii.n a-* mii a-. jur.'.-ible and uot to bo immediately foneermd with first aid 1 am .'mv that you doctors do not lo>.- right of the fact that once a railroad mail clerk starts outtut bi rut:, lie Imishe* it. Thai may mean eight Lours before b<- ha* anopportunity to come to the end of his run where he can get medical attention. 2 believe there t* a difference, too, in the accident exjmsurc which our people encounter. We have. in effect, a .'hop ojK-raiion on wheels*. Our injuries are thereto;e jomcwiiat different from those you encounter from train crew.'. For exump!- su-.fi things' x* tough wooden surfaces resulting in spliatti? me a frequent type of injury, burn.' irom exposed steam pipes are not an uncommon source of iujury. Cuts from very* sharp objects, as well as a clerk occasionally putting his hand through a window with resultant lacerations os ourcv> of injuty, Strains and hernias are also a common type of injury-. well as bruises due to rough coupling of mail cars. TjiE CtiAlkMAK: Have you read over our little First .Aid instruction booklet? Mh. Lanhuy: Z have not hud au opportunity as yet. Tas Chairman: Th:` cwr> h h>t <i our thinking. That ha*. Urn revicd tilin' and Uin* again. ami 11 jv* tty unich why Lav*- huih-d thiugs down. We don't like tin- u- of dtug* W. d<x.t like wound.* col* on-d with lod.tu- or im :iin-fi:otm' and .' on That mUibrc- with tin- doctor.' examination. Mtt. J,am>ky: 1 can umlci'ijtid your point of view. J would like to make mention of Un- design of the first ant kit cuitUum.-r. One Uhtig that caused us to ask for a watertight uu>! nought and dust-tight kit was be cause railroad mail cars certainly cannot be kept as clean as this meeting room. We felt it wus desirable to provide a good, serviceable, long-time use container and one (hat would keep the contents of the kit in as clean condition as possible. Such a container would also assist to preserve the sterilcuess of the materials encased in it. I 1 f i 1 Tm Da. t app< about problcr first ai' diflcrei ever, o as gmx r<>WTi *t p u* hazard into--if minor rxjsii* ru(ii|4i< allow t wa'h o with w an apj pill a rewriting I tY My aerrr they . *- d. possible That office* meat on th Dw. silu.it Wi st all your if.UU We wc d( clerks nftes eiati* Da i may be kit Dr. cal after i* we are cu I say '..ik selves dly have mpuious i v r-fer- ailroads ophy un hey will ob, then railroads 1 not to once a y mean hia r :*:h o. Our e from suiting a pipes ecta, as v with also a of mail ; :i been boiled Is col:h the t r; proceedings of Medical and Surgical Section 75 Thb Chairman : Dr. Graham, do you have any questions? Dr. Graham: There are several comments. The Post Office Department is apparently going through a phase of first aid experience that we bad about twenty or thirty years ago when we were faced with the very same problem. I think the Canadian roads perhaps have the best experience on ft first aid training. Their exposures and environmental exposures are a little different from llie average American railroads in some instances. How $ ever, our observation was and still is that the Red Cross traionig, being as good u? u is. is .-i ill deficient so far as proper core of these injuries is concerned. From the safety standpoint, I think you are taking the right >lep in furui-iimg prot.-eii.tti to the*! individuals who have a .p<vial hazard in ivo r-\|>o.ur*\ but alter you have done that, then you will run into--if you depend upon your first aid train men to take care of these minor foreign bodies in iHe eye--the <:unc thing, perhaps even more. Your i experience is going to be even more so than it has been in the past of i complicated eye infections, which con. in my opinion, be cut down if you i allow those individuals to let natufc take its course in most instances and i9 wash out those foreign bodies, or advise them to use a lavage, a douche, \ with water to attempt to wash out those foreign bodies, but not to use an applicator or as one railroad conductor liked to do over the years, 1 pull & horse hair out of his collar ami make a loop of that and use it with resulting infections which frequently occurred. \ I think the important thing is to u-e tlw simple first aid treatment pos sibly ns .Hjfg'-'ird in the A.A.K. First Aid Manual, and then I think you agree with this in your program, although 1 don't kuow. Advise them, if they continue to have trouble, to -eck medical aid. Mr. Landry: Our instruction*, Dr. Graham, to alt of our pimple in the postal service is to get competent medical treatment as rapidly a* possible. That is no; too difficult a t i>k iu our railway mail terminals and post office* In-imU''* -ac have, it Ira-t in tin* larger location* a medical depart * ment or medical unit: That i-n't the cae when it. rentes to the road men at :si** r.lii'.v and ai *. !)k. (iaviiwt: I think that -. it iti<>it you or in is .-rv -huilar i 'ifiiiion of The Pullman (`unpitiy. We have no men over the line, but we have ?;.. railroad arg on* at nil of thoc towns and cities that wr .-an depend on. md in cm* rg-nci^ your rail conductor can wue aln-ad md have vour railroad doctor c<mv tlowtf and lake care of your ease fur von. Mr. Landry: That is an interesting sngge-tion. At the present time we do not make it a practice to hold up the train to have one of our clerks treated. More important than that, we do not'tiave any established medical service along these lines that we ran call on except in the larger cities where the Bureau of KmployeV (hxuprnsation have designated physi cian.* to take care of federal employe*. But your suggestion is certainly an interesting one that we might want to give it further consideration. Dr. Wm. Hresirrs (Chief Surgeon. St. Louis Southwestern Railway acr _JiJ. jnrti'iiS'i *Uufe 76 AmocuzIvm />/ Xmmcan #ai/roa/i Lines): Do you recommend your train employe try to remove foreign bodies, while the train is in motion, with an applicator? Mg. Landry: We would not want them to do it, of course not. Dr. A. Neepayer {Chief Medical Officer. Reading Company): May I sav this to you. when you mention prophylaxis that is about the ideal thing and only thing you could do. As Dr. Graham mentioned, the eye mechnnirally will ejr:m itself of an ordinary foreign body. Now. you will have three tyjH** of foreign Uwius. Th< r<* is the foreign body that lodg*ill tin cvr and nil.vbe^ ifvli (> tin hhii' V* rv often tin- ev will liiecliniiH ally r |i ,iii nut lh<- fun urn l*<ly. Il in.iv nr may iml. I,ill umiiiIK it duHowi ver. whin you *om- in the hot rind* r whic.h unlwd.- ils*-ti inlo the 'ouk.i aiid ptnbaMy |.mdu.<s a ':iin. nfiil.'i you nor any on* d.*< is going to n mow it, and it von have a M* i I l.ody or have a splint ~ or anything lih- lh:.r whieh unb*-d- in the coiiu.; ami trfoj.i!i- tkctMTH a, no hor* >;-iir 01 anything <1- going to :< leave it. Willi the imlxdded cinder witii slaai or without staining or jn-rforittion of the cftiuea. yon mod aiies:m.-i:i lo take it nir. I have yet to find n man with enough coinage Jo stand up and h-t me take it out. Mr. Van Horn: May ] ask Mum-thing? How about putting a pud over the eye for the time bring? D. Graham : Uitle.-s it .< a snioiis injury, usually the, eye and laerimina* tion, simple douche with ample water arid mopping the eye it-srlf with a clean cloth, will take rare of that situation. Mis. VanHorn: I have hto in tie- 1`ullm.ui shops in Chicago wherI got something in my eve. 1 couldn't do anything with it. I would keep my hand over it like this (demoiisiiutuig). Of course, it hurl like tin deuce. Finally, of course, 1 went to a doctor. Dr. Graham: That is the important thing. Mr. VanHorn: What I wa tanking, if you had a pad to protect it-- you know, you are houud to wink your eye, something like this. Mr. Rank: Dr. Metz, I don't w.uii in m.-h the subject but fur tie- sake uf M:. Laudiy. I humv U- ha- to catch the train at 4:30. I am satisfied you turn niher /*. ,,n |j,e agenda. I am wondering if Mi Lan-hy d-*iil hnv* :.li ij.e i;,f'*rmnfioti h*- ninv nni| Jo consjd*: this subjwi fuitier, and having :n mind that Mr. Landry is available and iu w :*'!.ii,^,o:i v. ; *., I . :ii.it I.. f\w-. n 'uu* on** ynu might d'-dg- ti:i!( and Mr. J.ami v. !i,*y in,:;. .() will, soliK thillg thd might L \ ery simj-u Tm. ('jjukamn. Mr. Landry, i.m you get in to Chicago once iu awhile? Ma. Landry: Yes. The Chairman : Dr. Graham is with The Jhillman Company. He has cars all over the United States just like you have post office ears all over the United State*. He is very familiar with that kind of work. In fact, we all are here in our respective areas. I think this would be, now that you see what our book of instructions U. what Dr. Graham has in mind, and you have your certain ideas in mind. I think it would be well for you , -t | ( and Dr it out y. would ; advents possible Gent I from o: You ? aind. n snvlxtd' evrrvlx ehmiid Du. r hr thi* MAS-21 (The The ` I mig that we wicntiar wee have here; tl nil a n If any they ea: '1KT. SfiOO in cento, a It 10 sf courearpensi' oot, I t Gent! the K<, I*. ) Railway year it eporte. ovo foreign of. D: May I >. U..r id.-al d, liii: vyr v. you will !i.: lodges vr .viiI ' r. ti->u iJv :ia-<l.s it.M'li >r any ijn*' a splinter onres the- i-Tiiratioa to rind a pud over lacr. 'f wi. Itfo rth.T" >vM k'..V I'v.' "... it -- t i-.r i;i `ndi-rim: <'>r. Jid<r might !*' mice in He has all over In fact, :ow that n mind, for you Proceedings oj Medical and Surgical Section. 77 and Dr. Graham and any other committee to put sit down md discuss it out just ns a small group of two or three fellows together and then you would pioli.il.lv ueI. a li>l nf pros ;uul con* :is It* Uve advantags* and dis advantage* of certain things. We want to help out and do everything possible, just as well n we ran. That is what these meetings are for. (ii iiiliiii'ii. we will m11riu<- with Dr. (Iraham's report and di.scu.ss it V. from our own railroad point of view. You have heard the Ji.-m-ion from the Past Office, what they had in mind, and ippai.nriy 'hey are willing fo df down and talk about it. Does myhodv wirir <> i-k Dr. fir.ih.un .my (ursiiooa about his paper? Docs 'v. rybodv appro* < Dr. f'.lahatn's report as to what the first aid packet iiould << ri f * in ? Dr. Rksnktt: I i loiuujriid 'In; standard first aid packet be approved bv this group, as presented bv the Committee in proposed revision of M,fc3-217. (The mol ion was July *-eondcd. and carried.) The Chairman: Is there any discussion now? I might say I presume that you have ail seen this sample (as distributed) that we have in front of us. This has the specifications that Dr. Graham mentioned, and they have added this little roll of adhesive. Of course, have mir 1.: tie first aid booklet, and that can be folded and put in lu re; that ,s. y.nir fir*t aid packet, minus the adhesive is what we would call a minimum park* t. If anybody .vifpi ' j add .if.-iy pins nr anything e|e in it ur adhesive, 'key c:m do it knowing it will cost a litfle more. I ( Dr. Br.NNF.Tr: Did you get a price on it? Tub Cmuiimiv Thi-> nu-ial h>v ui.ulr up as it w in tpnt-.fitics of o.fiOO in ihe ini'! il ki? is approximately XI cents. In the plastic kit it is 13 uni n i; U.'urd hit i' i- ttf 'uts. Tl.`-e are * -limated prices. It is 10 cut* -dii- tf in 'h** cardboard as compared with 'he metal, and >f :our**. "v . H-< . ii. a, .-? in .(.- pU.-tie. So the : v 'al is the most xpensiv*-, `htii pIi'C' and `T n V- ;-ij*-r. If they l-|t the li'fle adhc'ive i nr, I don't h-.v/.v -.vr.t it old . u* -!!. thnflen;-n. we iru-t. nui? now. Tim next i;em on !hc Program is h- Urjuirl ai l'niui.i:,,fi. ..ii Ki'ai-rur- . Dr. F.ve? s Dr. Dc.vi'ax Kir ii.l.ief Surgeon, Xadiviile. Chattanooga & St. Louis t Railway): Mr. Chairman ir.d Members: Our Committee thought this year it would be wise for a few of us to just outline some interesting cv * reports. The Committee Keport, therefore, reads as follows: rc**ie*4 **or.***- 78 Auocialion of American Railroad* (Circular So. M43-293) ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL 8EC7I0N REPOST or COMMITTEE ON FRACTURES t)r. >.*r (CJ.airman), Kurjr*,<n, .V'h*i)li Ctiai(^no"r & Sr. I.ouif l>r (i r*rH..r>, `Wf *.,- fi-i.u I'inriniaali. ,Si Orl'H"-. <( Ti>. I'anf.c Hllua\. l>r. <. F. Hollvri. Cl i<f Surgi-.n. OnIral o( Gv.uffia Kh.1*t. ]>r. 71. \V. Plnrkw.JJ CbM Surc'-nn. am} Sb*>rr> Lin* Hail rntil fir J. Ilirlx-r Wumrr. Nurr<*nn. r.i .H. u..-r ^ Jtatr k.rir Kaitrnail Chicago 5, Illinois, February 2$, 1951. To the Menial asi Surgical Sixvjon : Vour Commit:''*.* on Fractures respectfully submit* as its report a series of paf-cra propped hv Members of the Committee. The first three constitute actual case histnrit-s, nuiiil*er* one and two having Wen submitted by your Chairman, and number three by Dr. 11. W. Stockwc-H. There is also an ''Outline of Management of Low Bark Sprain.*," a? written by Dr. J. Huber Wagner. The*'- papm arc- prc.*en;tti simply as a matter of interest and information and it h hoped that they will bring out di-cu^sion which will be beneficial to those present. Case History No. 1 (By Dr. Duncan Ere) Patient: W. T., Age 41. On Si-plcmWt 0. 1049 tLis patient was run over by a truck 30 miles from Nashville, Tonci-isce. the wheel pacing obliquely over his right hip region as he lay prone. He was taken to his local hospital where X-ray revealed a posterior dislocation of the right hip together with a fracture of the posterior rim of the acetabulum, a single large fragment being displaced 1H inches upward, lmdir grmral fimyih. .-ia the tli.-;]>K.hlioa of the hip wa* mlm-f-d, and he way immediately referred to me for further treatment. When fir.<t seen esamimi'ton rcv<.drd the alxlomon to b' fiat with a moderate amount of involuntary mu** lt spasm, tindcri.cE? and rebound tetidrrne in the lower abdomen. Catheterization produced six ounces of bloody urine. Light miner* of saline fluid were placed in the bladder and only two ounces of bloody fluid returned. Cystograra was )>ositivc. The abdomen was opened and a very large rent in the fundus of the bladder was found. The bladder was repaired and the wound closed without drainage. A large Foley catheter was placed into the bladder. The patient wa brought back to hi-* room and the right limb placed in Russell traction. In eight days the patient was operated on for the frac tured acetabulum under spinal anesthesia by the posterior exposure method. l*racecitiny.i u/ M cUicul an<( Surgical Section 79 The patient was placed upon the sound side with a kidney support. For the skin incision only two landmarks are necessary; the posterior superior spine and the upper anterior angle of the greater trochanter. The skin incision began about 2\*x inches in front of the posterior spine extending slightly forward to the upper anterior Ixmlrr of Urn greater trochanter and then live inches along the line uf the thigh. The upper port of the akin Incision outlined the upper border of the gluteus maximus, and this muscle is retracted backward. At thi.* -fage ail the umvlea to the greater trochanter come into vi-\v--gluteus ue iliu.'', aluien..- minium.*, piriformis, oblmau>r intermix and gi-melli, obturator < \t rnus and quadratus femoris. The next step was to detach some of these muscles from tlie greater trochanter. The gluteus medius and minimus were retracted forward. The insertion of the piriformis to the tip of the greater trochanter was divided and the joint proper was now in view. The capsule of the hip joint was scon to be torn and was enlarged. The single large fragment was seen and was displaced upward and rotated. The fragment was placed in its normal position and fixed with one screw. The wound was closed in layers. The patient returned to his room and was placed back in Russell traction. The patient had primary healing of the wound and remained in traction for two weeks. He was discharged ou the 22nd hospital day and instructed to remain in bod for two more weeks and begin the use of crutches with no weight-bearing on bis tight foot. The patient reported to my office several times and was Ji.M-hargcJ in April 1950 fur regular duties. He did not have any complications from the two operations. Conclusion: The posterior approach method to the hip joint is safe, rapid and practically bloodless. Case History Ho. 2 (By Dr. Duncan Eve) Patient: H. E., Age 51. History: June I t, 1950, fell from Hide of box car, which was in motion, injuring his left thigh. Patient was brought to St. Tliom u llo j.iful and x-ray m idc of his left thigh. Diagnosis: Simple fr.vt'iru uf 1. ft I'. imir at junction of middle and dutul thirds. Treatment: June 14, 1950, under -pinal ntir-thcsia the entire left hip, thigh and *knoc were prepared and draped. A five inch incision was made on the lateral aspect of the thigh at the fracture site and the fragments were exposed. A guide pin was inserted up the proximal fragment and brought out through the superior aspect of the greater trochanter and an incision made in the skin where the guide pin was pointed. A reamer was then inserted over the guide pin and a hole was drilled through superior surface of the greater trochanter. A Kunscher intramedullary nail was inserted over the guide pin and driven down to the fracture rite. The fracture was then reduced and held in reduction with a clamp and the nail driven well past the fracture site. Wound closed in layers. Patient was able to leave the hospital on June 25, 1950 per ambulance and returned to my office on crutches July 25. The x-ray showed good 80 A**Kvtlv>n t>J Auuricnn Htwiroaia position laid fair amount of callus. He rras x-rayed again at my office on October 24 and the x-ray showed good position and good union. He began light bearing weight on this date. He discontinued the use o{ crutches the Utter part of November and was discharged to return to work on December 1. Case History No. 3 (By Dr. B. W. Stockwell) Patient: R. J., Age 23--Fracture of Humwus with Complication. History: This 23 year old railway switchman was injured nt one am. on May 21, 1919. when lie was rolb.-d between the side of a box car and a brick wall. He \va.* taken bv ainbnlanci to Harper Hospital, Detroit, where examination in the emergency room revealed that be was suffering from severe shock; a displaced fracture of the left humerus, with radial nerve paralysis; fracture of the srupvtioi and inf liur rami of the right pubic bom-; traumatic rupture of th- umbra, and multiple fiacttirey of the tipper seven left ri!r. Initial trenrm* j.i l uii-re* <} ,,i u,r;I,, i. iif.. :ran.-fiisioris fur shock; the fractured left huim.ru. was j-plmred Jollowing rorrrctiou of over-riding; an unstjrc-i s-ful n}jf mpt a* mad* i>* er:li u it**- th ruptured urethra, and tle patient was admitted to the hospital and placed in i*n oxygen Unt. Eight hours later, the patient wot. out of shock and his general condition was satisfactory. H- wa.' th> reff>n- taken to tb- operating room where a suprapubic cystotomy wav dune and a retrograde catheterization of the ruptured urethra wa carried out. The specific injury which is to be discussed at this time is the fracture of the Mt humerus. Initial X-ray examination was made with the bed-side portable unit. It revealed a badly comminuted fracture involving the shaft of the humerus at the junction of its. middle and distal third#, with con siderable angulation of the fragments at the point of fracture. Clinical examination showed a definite wrist drop with characteristic sensory changes indicating an interruption to the continuity of the radial nerve. Due to the patient's serious general condition, the fracture of the left humerus was not disturbed and the simple first Aid splinting which had been applied in the emergency room was not touched until June 2, 1919. On that date the plaster cart was taken to the patient's bed-side and a hanging planter oa>t applied, extending from the upper j*oliun of the left arm to and including the wrist, and splinting the wrist in the position of function-- a cock-tip position. A loop w.v pl.ui-d :l the elbow for traction. The traction was applied to this hanging curt with pulley and weights. The next X-ray examination was carried out on June 4, 19-19, and is reported as follows: `'The examination of the left humerus was made through & plaster cast and the position and alignment of the fragments at the comminuted fracture, junction of the mid and lower thirds of the humeral shaft, is good." The patient's condition during this period was somewhat critical and for this reason it was found very difficult to keep the traction in place on the i I j i I I i ii *i> X- was c fr tl Bk hr in in Cr su A July On was ret As mold exercise The showed increase flexion nations By was r> regain thumb Phye Report of Committee on Frocturee 81 OD left humerus, as mentioned above. Thus, on June 22, 1949, an additional s'30 portable study of the left humerus with the plaster dressing was made. the This revealed: on I "There is some anterior bowing at the site of the fracture, which has I occurred since the former study." For this reason the traction was increased by placing additional weights $ at the foot of the bed, and on Juoe 27, 1949, & check-up X-ray rcveaied: "Study reveals a comminuted fracture of the elbow and humerus ns previously reported. Tin-re is definite improvement in the position of in. the fragment* as compared with the but -.ttidy, (he position !*`tng i a satisfactory in both planes at the present time." '.re On July 22, 1949, the cast was removed and another X-ray examination om was made. This was reported os showing: rve is; f. "Re-examination of the humerus in three projections following re moval of the immobilizing plaster cast shows that the alignment of the !'in fragments is still very satisfactory, and was essentially unchanged since the last previous study of 25 days ago. The amount of callus has not :he increased appreciably, and it is taking place mostly in the form uf in bridging. This bridging has occurred mainly between the small inter .he i on mediate fragment and the large distal fragment. The two main frag ments of the humerus which are separated by approximately half a centimeter show only a small amount of callus between their adjacent surfaces." \ A new hanging cast was applied and the patient left the hospital on July 19, 1949, and continued under ob.-orva'ion in our office. of On August 23, 1949, he was sent back to Harper Hospital where his cast cie was removed and another X-ray of the left humerus was made. This was ut reported as follows: .' "There is a* yet insufficient union to permit use of the arm except in a very guarded manner and in passive movements.1' 1C As these Rims -Jiowcd a minimal amount of callus, a posterior plaster .a! mold was applied whii-h could be removed for physiotherapy, hydrotherapy, exercises and ma.-sago three times weekly. ft The next X-ray examination was made on September 19, 1949. This ^n showed very slight advance in h-aling unce the last study, with some at increase in deposition of calrinm at the fracture site, without change in '* position. Physiotherapy wa* continued. to There was also definite evidence of regeneration of the nerve and dorsi- fiexion of the left hand and abduction of the left thumb was present and. le although weak, showed a very marked improvement over previous exami nations. is Physiotherapy was carried on three times weekly. The patient was instructed in occupational therapy, and also concerning exercises. By January 15, 1950, the elbow motion was excellent except for a lo.ts d of approximately five degrees of complete extension. The wrist joint motion t, was now normal and dorsiflexion of the left hand had been completely regained. At that time there was only a slight loss of abduction of the left 3r thumb. There was moderate disuse atrophy of the entire left arm. Physiotherapy was continued throughout the year 1950 aod the patient t I l I i \ t ! * i ft i V 82 Ateodation of American JiaSroadt teen at regular intervale. During this time, active uee of the part in order to overcome the disuse atrophy was urged. Numerous attempts were made to find a job for him at light work and they were all unsuccessful, because of lack of seniority, various agreements, etc. The ease was in litigation and it was obvious that the man was not going to return to work until his case had been settled. By the middle of September 1950, we considered that he had made an excellent recovery from his injury*' There still was a small percentage of disuse atrophy of the left arm, due to the fact that he had not used it and had not cooperated in his active motion and exercises as much as we had desired. There was a very slight losi of complete abduction of the left shoulder which was felt would be completely relieved in another few months' time. There was complete regeneration of the radial nerve and at that time there was norm.il extension of the wrist joint and also normal abduction and extension of the thumb. Conclusions: This is a ca^f- report of a fracture of Ibc mid-portion of 1 hi* shaft of the hft humerus with the frequent and common complication of radial nerve injury. This nene injury is the most frequent serious com plication of fractures of the shaft of Ihe humerus. The reason for this complication is because of the intimate relationship of the nerve to the humerus where it lies in the musculospiral groove. This case was treated by a hanging cast with traction over the end of the bed during the period that the patient was required to be in bed, and with the weight of the hanging cast acting as a traction mechanism after the patient was allowed to be ambulatory. No surgical intervention or exploration of the radial nerve was required and the patient's nerve made a complete and uneventful recovery. This serious fracture required a long period of immobilization in plaster, and a very long period of physiotherapy, occupational therapy, and psychotherapy. The end result was excellent with a very small degree of permanent change which, in our opinion, was not disabling. This represents a simple method of handling a common injury with a serious complication. Obviously, had the ladial nerve been completely tom across at the time of injury, surgical intervention with suturing of the nerve would have been required. This case demonstrated that there may be complete interruption of nerve function without complete severance of the nerve. Outline of Management of Low Back Sprains (By Dr. J. Buber Wagner) In al! cases of low back sprains or low hack pain it is very important to obtain a detailed history from the patient. Id ca.es where an accident i involved this should include when and where the injury took place and th* exact mechanism of the injury, i.e., was the patient bending over, was he erect, did he slip, was he carrying a heavy weight, did be suddenly twist, was he lifting in a stooped position, did he fall and land in an awkward position, etc? This is of importance as it often gives one a lead aa to what type of atres or strain was involved in the production of the injury. For the sake of discussion, these cases will be divided into two main categories--acute and chronic, and the management of each will be given independently. l t -ft in order to were made to u, because of $aiioa &nd it uoiii bis csss had made so percentage of t used it and h as we had i of the left ' few months* ^ at that time af abduction ortion of the implication of serious com`Soq tor this nerve to the ' w*s `-eated t riod >&* he "`as *...^wod 'f the radiaf i unciY-otfid bilkation in therapy, and >(/ degree of J r*>preent3 inp)icitioji. the n;mi <if ( f- <-n icr Wagner) nportant to ; .i.-cidfent is !.ice And the jv^r, was he iy twist, was Report of Committee on Fracture* *3 CUTS: Signs and symptoms-- 1. Pain in low back region. 2. Spasm of erector spinae muscles. 3. Lose of lumbarcurve with flattening of back. 4. Limitation of motion in flexion, extension, hyperextension, rotation and laterally. 5. Back moves as a unit rather than as a group of segments. C. Posture and carriage is one of a partially slouched nature so as to protect the low back region. 7. Tenderness usually elicited over lumbosacral and/or sacroiliac joint areas. 8. Usually find a tenseness of the erector spinae muscles in this area with occasionally presence of a serous effusion. * 9. Presence of hamstring spasm in the greater number of these cases. f X-Ray findings-- 1. AJP view usually negative although at times & scoliosis to one side or t the other may be noted; this is often due to muscle spasm. 2. In lateral view there is a flattening of the lumbar lordosis with loss of normal convexity. Treatment-- 1. Injection of ihe lumbosacral urea u.i well as the lower lumbar and upper sacral areas of the back is the treatment of our choice. In this procedure le/c Procaine is injected into the region of the posterior lamina, infiltrating the erector spinae muscles in the region of the lower three or four lumbar And the 1st and 2nd sacral nerve roots. This procedure is curried out umUb niUy <>r bilaterally as the c;wkv may demand and about 2-3 cc of the solution is injected at each of the nerve root areas .-so as to block the posterior or sensory nerve roots, relieving the patient of pain. 2. The patient it :!u.n duun.di.itely <eut to the physiotherapy department .............1.1 [ r. ic in ilur .\n:n of moist air is givr.-u for 20-30 inino'. Foil*.wing ilus, gntdiinf.-d tuu-cular enatrictions .are given xuw.uit of ?i;;n'il.ition is eontrolled by the physiotherapist so that a gwod niu.-cul.tr uoutraettun is obtained in a gradual manner without pain to the patient. Gentle massage is then given over this area for 15 minutes. 3. The patient is then immediately made ambulatory with no strapping or braces and active motion is instituted and insisted upon. The 4 patient is shown these exercises which consist of bending forward to touch (he floor, (tending backwards laterally, making a circle by bend ing at the waist, rocking in a rocking chair, and sitting in a straight back chair and bending over to touch the toe* of the left foot with the right hand and the toes of the right foot with the left hand. 4. In cases which do not respond to this type of therapy within a period of 3-6 days, manipulation under anesthesia is then carried out. Thia consists of hyper-iotation of the back both to the right and to the -f'F*: 84 Auociation of American JtaUroode left. Physiotherapy as described above is then given daily. These manipulations are carried out in the operating room under deep pentothal anesthesia supplemented by curare. This regimen is sufficient for treating the greater number of this type of case and usually no other treatment will be necessary. However, a few cases do not respond satisfactorily and go on to a chronic stage, the management of which will be discussed shortly. In addition to this small group, the remainder of cases which fall in this latter cate gory are those which were not seen by us originally but are those which were in the chronic phase when firvt examined in our clinic. CHBONIC: Signs and symptoms-- 1. Fixation of the low back region with all motion being as one solid unit. 2. Marked flatness of the lumbar area with occasionally a tendency toward kyphosis. 3. No tenderness can be elicited in most instances. 4. Limitation of motion is marked as above but is leas painful. 5. Patient may or may not have a list of the pelvis and/or a lumbar scoliosis, secondary to the chronic spasm of the erector spinae muscles. 6. Hamstring spasm of various degrees. 7. No reflex changes. X-Ray findings-- Essentially the same as in the acute cases. Treatment-- 1. Manipulation as described previously, these manipulations being carried out under pentothal anesthesia, usually about one week apart. The number of manipulations necessary varies with the individual case with the average case having two or three and being in the hospital from two to three weeks. 2. Manipulations arc followed on the same day by physiotherapy as described in detail above and these treatments are continued daily throughout the patient's stay in the hospital. 3. Active motion is instituted following the physiotherapy treatment on the day of manipulation and the patient is instructed and is made to carr>r out these exercises throughout bis entire stay in the hospital. 4. Following discharge from the hospital, a small percentage of tbeae cases are asked to report back for physiotherapy; usually about three times a week these treatments are given to them as an outpatient for one or two weeks before they are returned to work. 6. Patient is then returned to light work and is rehabilitated to his regular work as bis back responds. This period is quite variable and indefinite and ranges from several days following discharge from the hospital to several weeks. The above regimen is only for acute and chronic low back sprains and strains and is not to be used as a therapeutic measure in eases of spondylo listhesis, subluxation of lumbar vertebrae or ruptured intervertebral discs. i if In a prjc and for : pure rupt Of IT a- K`P" Kept, Dr. Mr. i Tl.' of m. unh-athe . used . of the We lesion what what . menu infusk the in He as- We so th* they c with i minim instant We i cent F proprie as a si This is local a: 1 am days. \ the no gave b was str \i!y. These inder deep of this type . However, ,-oaic stage, Edition to latter cate; are those ir clinic. i one solid v tendency il. : a l>-*bar xe n *. oos beiog cek apart, individual ng in the h'Tapy as .ued daily ament on 3 made to .capital. ; of these jout three atient for cd to his aahle and from the rains and ipondylo>r*l diset. Report of Committee on Fracture* 85 & Id addition to this, may we add that all of these cases are thoroughly studied prior to manipulation, a detailed history is obtained, a complete physical and neurological examination is carried out, X-rays are taken and reviewed for the presence of any bony pathology. When the definite diagnosis of a pure sprain is made then this treatment is instituted. In those cases where ruptured intervertebral discs are suspected, they are further studied by means .a- of myelograms and treatment is carried out as indicated, Rp.-pccti'ully submitted, Committee on Feacttjres, Duncan Eve, M. D., Chairman. (Dr. Eve road Case Histories N'os. I and 2 as they appeared in the Report and then called on Dr. Wagner to present his portion of the Report.) Dk. J. itciihic W.minks (Chief Surging. Ih-.-vK'mer <fc Lake Erie Railroad): Mr. Chairman and Cent lemon: The hour is getting late, and you all have a copy of this outline I made of management of low back sprains and low back pain, so I won't read it unless you care to have me do so. It is pretty well self-explanatory. It is it the method that we use in our own particular clinic. I have personally used it for a period of twenty years or so and it does put in treatment of these low back pains and strains by the injection method. t. We evaluate our cases as to the possibility of what the pathological * lesion is relative to the injury sustained, whether it be direct, indirect or what not, what particular motion he was in, and then try to visualise what might have taken plam in flnw inux-Int, hrlii-ving lht thr; fundn- meutal cause of pain ia the wearing lirst of /mj.vlc* themselves with an infusion into the imu-clc -h< till, prursure ou torn nerves and bo forth, and the fixation of tin* bwk io ifiat ihc prtii.ni. can't move bci'aii.w of pain, fie .bournes a i-ri.uu j 0-1:11*0. We treat tlo -e .* .mnu-iliao'ly by the injection into *hese muscles, v 1 that they .r- n-livM-il nf pun. md 1I./11 i-k tln-in to * \* mse as much as they can to carry on the normal physiology <,f liie muscles, believing that with action of the muscles the effusion is milked out. There will be a minimum fibrosis, and the patient can return or keep to his work in many instances. We use in that injection, as outlined in the paper, one-half of one per I- cent Procaine for the immediate effect, and we also inject in there a proprietary called Serapio made from a Peruvian tree bark which acts ss a slow anesthetic. When the Procaine is gone, the Serapin takes on. This is the theory of it. The fact of the matter is it acts as a prolonged local anesthetic, permitting the patients to go about and be free from pais. I am sorry l didn't bring pictures with me. I could show you one, ten days. We took a picture of him. He was ail bent over, listing to one side, the normal lumbar curve obliterated, and walked around like this. We gave him that injection and forty minutes later took a picture where he was straight as he was beforehand. He couid bend over, touch his knees. -*> - 86 AuocuUion of American RaSroad* and following physiotherapy treatment was able to go back to bis work. After a period of treatmeot for tea days we lost sight of him. He was completely well. We get chronic cases. The pain is not so bad, and there is not ao much restriction in the movement, but free movement is restricted. We believe these arc due to these cases that have been fixed and permitted to be strapped and/or put in casts or what have you. and then permitting thi.~< effusion that takes }>i:u-r id this muscle sheath to organize into fibrous tissue. We treat those things by manipulation, hyperroUtion of the shoulders and the pelvis, the shoulder one way and the pelvis the other. Wc do it on the opposit'- side so that r behove we are breaking tip the adhesions that may he ilu-r< and coating an nvuie sprain from a chronic sprain. Then we go along and U'.-P them the vtnu- as wc do an acute sprain. We also um: m this milking out pi<* or attempt to get physiological motion 0! the muscle- of the back the Morton Smart machine. This causes a physiological contraction o: ilw imwl< - without pir.n unless yon carry it to the (\Uiicr Imios, and that poind' the patient again (o realize he can most hi< Uuk and by motion he really gets hiui.self well. The manipulative treatment i.s afiei the method advised by Bankhart. He is an M.b. manipulator, iM.lJ. of Liugla/id. You probably know him better than I, hut we follow his treatment. We have gotten good results in this. This paper speaks for itself. 1 have been questioned several times as to, "Well, how do you know whof pathology takes place? What is the pathological Jr.-ion that you find?" I don't know. The only thing 1 do know is that it is comparable to a cbarleyhorse. If any of you have ever had a charlc.vhorse, you know that when you use that ebarleyhorse and use it within limits, that it gets well faster than if you leave it alone and let it go on to fibrosis. Of course, in these back eases we trent acute and chronic sprains. We rule these out, the other things as such, as fracture of the ilium, disloca tion, subluxation which is very unusual without fracture, nucleus hernia tion, spinal lordosis, congenital deformities aud so forth. We rule those things out before we do any treatment. We are talkiug about treatment of the ncute back sprain and chronic back sprain. On an average, I suppose probably, in our particular hospital we run about 60 pnlirnis. and I would dare say you could go in there and you would see at leas: >ix or eight U<-k r:ws nil the time. They are transitory. They are not the Sam- ours; tnidc r-;.,tid. but they are transitory' and they keep on coming and going, so wc have loo many of them. I don't know whnl pereemape of our overall treatment are back cases, but I know that ooe is too many. This is a method of treatment that has helped us materially. I think it has helped us too well. I get too many back cases referred to me, and 1 don't like them. They arr the most troublesome things you have in the wav of treatment, but if v<m care lo rend thin or if you have read it and don't believe it. 1 will U- glad to argue it with you. If you want to go further than that, I can invite you to come down and see us. i J l T. it n n Al tai is sue ] tw< the by Mr bet It all At supc just T fract musr F his sum to '< 10 his work, him. fie was i-t not so much d. Wo believe emitted to be ,.<-rmitting this i !ihn>u tissue. ;hu shoulders \V>: do it the adhesions :uo -praia. o acute sprain, t physiological This causes .!c.'9 you carry *riia to realize well. by ~ okhart. bly w him n results . oral times as What is the i charleyhoree. when you use faster than if : >prams. We ilium, di.-1.icauidrus lu iniaWe rule those ;i und chronic -pita) we run here and you are transitory, tory and they re back cases, meat that has cases referred rte things you r if you hare i you. If you aar* > xu. Report of Committee on Fracturxs 87 * Da. Nki;p\ukr: How much do you u-ually inject, how much Procaine and Scrapin'f t. Da. W\onkj: fbually in back ca-o-x 10 to 15 cc. We take 5 cc of ; Pror.amc arid 5 cc of Si rajun. We i-ipml it up, you gel a half per cent Procaine solution. And then the manipulative treatment is proper, and I also .should >iiy( 1 miwd something in ihis particular brieling. We iim; a moist heat in our phy.-iothiTipy. We use moist heat that will raise the !<<.d icmpfraruru of ih<` b.uk up to--whatevf'r part of the body it is--IUS i<i lit) d',gr--<,- with -oiui-ti:in-s ifn* rnlin: -y^b-mic reaction going up as high a.s 101 or 105 p>r a period of forty minutes to an hour. What is the rationale back of it? We believe by creating a hyperemia nature aids in absorbing the effusion. Da. Neppaukr: ITow often do you give those treatments? Da. Wao.ntr: The moist heat? Once every second day or in the very acute cases once every day. We have these in several of our mills. I am talking about the steel mill now rather than from this standpoint, but it is the same trauma, but do them every day. We have had really excellent success with them. Dr. >'Kt'p\i'KK: Do you '*:ty you get them back within about ten or twelve day.'? D .m Wminkii: Wi* get 'he rt.-utc back rases back immediately. We get the fellows back on their jobs working immediately. Dr. Eve: The next portion of this report will he Case History No. 3. by Dr. Srockwell, Dr. R. W. H(o< kwh.i. (Chief Surgeon, fb.uid Tumk Western Railroad): Mr. Chairman and Members, this 23-v>':u old rnilwav switchman was rolled between 'he life <>f :i bov ir <nd !>i>. k w ill id n t:\ined %e\rrc injuries It is a i:iu.-lmig i;.}> of 'lung. Tins young man stistaiucd fractures of all of his upper eight nh$ (-bowing -tide) and initially did not have a pneumothorax bui ,t !, r during ihn ruuvie of the treatment. At the i.m>; lime he Mi.-mincd a fracture of the pelvis, fracturing the .superior and inferior nnii of the pubic bone and rupturing the urethra just below the prostate. The injury that we are discussing today primarily was the comminuted l fracture of the mid portion of the shaft of the humerus with an associated musculospiral or radial nerve paralysis. From the scene of the injury he was taken to Harper Hospital where multiple blood transfusions were given and he was placed in oxygen and his condition was rather critical for some time. For that reason the first aid splint which you see wu applied. The Thomas arm splint was used as a temporary meagre and continued for some time because of the patient's general condition. After eight hours of treatment for his shock and unsuccessful attempt to cathcterize the bladder, be was taken to the operating room and the are '.X. V 88 Attocialian of Xmencon Railroad* auprapubic cystotomy and retrograde catheterization of the urethra accom plished. Because of his severe condition nothing was done about the fractured humerus for 6ome time. About twelve days later we utilized the so-called hanging cast inasmuch as it was the simplest method we thought that we could use at that time, and in a patient who couldn't be out of bed for a period of months it was obvious wc could use the simple traction of the cast. So a loop wae made and placed at the elbow for traction. Weights were attached to the cast and carried over (hr end of the bed The Kimr ivpr of traction obtained .1- i|in thr man is up walking about with the hi ighl of th< Hi' condition wav not good Hr ()< 1 i-lujii-d pii' imioiua arid if* u * and w<- hi up on tin- li art 1011 berate.' uf In'- genital condition, and you ran mo that during (he eour.-r of hitroaliniii! }io d. \ olej.od -nine ant'nor auculat loti which mold be very simply ronocied ly adding a little more weight which Wa* done. Thi* general type of alignin'nr wa- sati-fartory and maintained during the rest of in* lio-piiid stay. As commonly occurs in the fracture* in the junctures of the lower third and middle third of thr humerus and the same as in fractures of the junc tion of (he lower and middle third* td tin- tibia, there is delayed unioii and that was true in this case at thi* time. He hud fairly good callus, and we felt that no further support was required. After prolonged immobilization tx-cuuse of this delayed union, active physiotherapy was earned out which consisted of hydrotherapy, massage and active and pas*ivi exercise*. The radial nerve piira)v-is was noted on admission to the hospital, and the question immediately come* up as to whether the radial nerve is lacerated, intused. or function interfered with, whether passage of time will permit regeneration of the nerve nr whether ojen operation with inspection of the nerve will be required Thert was no problem in this ra-e because the general condition wouldn't permit the operative intervention until there were definite signs of regen eration of (lie nerve, and although hr hail evidence of complete interrup tion of function, within four weeks we could see muuc improvement in sensation over the areas involved, ami (lure was- gradual progression of improvement uf hi- mu-mlar powei The qnc-imi, <>! if habdi.'a!i'>ii uf I hi* Up,- of patient. 1 think, is soiiie- tlurig that mm on* all of u*. Thi* matt within a venr had made a good clujicnl rero\<i\ 111 * mm iunetmti hail bet n completely rvstond. Hi de! hav( M/iui di.-u*e attoj'l.y. but he wa- a train man and being a train man he hail in be- handled differently from the ordinary individual who has a similar injury. I say that for this reason that within six hour.- of his injury his case has lwen placed in the hand.- of attorneys from this city, and we had to lean on our files from them for future handling of his ca-e, and there wano ineentiw- fm him to return to work. In other words, he was interested Report oj Committee on Fractures 89 iu his settlement ;\n<l ho know he woiiM gel h good settlement and would receive his full pay for the full period off. We had great difficulty in getting dir man fo uo his Ann And partici pate in the active ami passive cxcrci.scs that are required in a severe injury that has had such prolonged immobilization. It is a very common injury with a common complication, and I think that it is an illustration of a case where the radial uerve may be severely contused, where function may be oomplwely restored without operative intervention. Dh. Eve: Thank you, Dr. Stockwell, and Dr. Wagner, too, for both your excellent presentations. (There followed a brief, off-the-record discussion of the report in gen eral.) Tub Chairman: Thunk you. Dr. Eve. You and your Committee are to be congratulated for your very fine discussion on fractures by giving us such case presentations. Is there any unfinished business to come l>eforc the Section? Is there any new business to come up? Tf not I am going lo n.k Dr. Hursh to come forward as our new Vice-Chairman. N'ot here? Tlu ti I will call on Dr. Hansen as your new Chairman. Will you come forward, Ted? (Applause) I want to give you my be.-t wishes for your new job, and you will find it a busy job, as you know about already. I want to assure you that the members of the Commirr.-e of Direction will help you out in every way possible. D . T.(.'u.wrman-Ei.ect r Han-kn' (Chief .Surgeon, Chicago, Hock I -land ,v. I'.udic K.ido-.idi I h.uik y>>u very much, Dr. Metz. I want to thank all of vmi for <-<*-rnliug me '!b- i,..mr It i< going to be a position Iii a ,> gomg :<. V- h.u'd i-j ti!I with Do lilu.'tnyus pi-'-doccors that I have i i'.ilbw, but 1 know tli.it with the r>.-t of she members of the Committee M Direction, i* well a* :hr j'l-rsonni 1. `hi* Chief Surgeons of the railroads, they will all work together. I am sure everything will go along very well. At least, we will try. Tub Chairman: I might >-ay one thing right here. I am doing this for Ted. There has been some discussion as to the time and place for your meeting next year. You will all realize that we are meeting here on Monday prior to the meeting of the American Association of Railway Sur geons and instead of planning a two-day meeting and a scientific session, we planned it so that everybody who is interested in attending a scientific session will get a three-day program following right on tomorrow, Wednes day and Thursday, with a banquet Wednesday night to which you are invited. It appears desirable to have this meeting in Chicago just prior to the American Association of Railway Surgeons as we seem to have a larger attendance in Chicago because of its location, than we do elsewhere, but we could go to Atlantic City or White Sulphur Springs or Biloxi or Saa 90 Attociation of American Haiiroada Francisco or any place you may choose. Let's have the hands on those who prefer to meet in Chicago as compared with other parts of the country. (A show of hands indicated a majority of those present preferred Chi cago for the site of the next Annual Meeting.) CiiAiHMAN-Ku.f'f J>k. Hankkn: If there is no further business to come befuii ihi> iiniinm. 1 will now declare the Thirty-first Annual Meeting of til' .M I an.I Mnt'.'.il Si Don adjourned. (Tin- lin -iuii* :i'l:ou! in ! Mm- dit :ii f <kj o't lo.-k, Monday, April 2, I9!*l.) Dft Amurii 11 Mi:rz. Chairman. H. S. Dk.vntinST, Secretruy. :> hands oa Chose -fher parts of the < at pff< rml Chi- r liu iin"%s p >am: '.ujiu.d Mi i i mg uf I i v, April i. I05t.) ; irwjilu.ST. S<-.-rc:taiy. rsr lieport of Committee on Fractures 91 REPOST OP COMMITTEE ON NOMINATIONS AT 1951 ANNUAL MEETING AND ELECTION OF MEMBERS TO THE COMMITTEE OF DIRECTION i)n. Win.i.wi T. IHvis <('liit-f Medical Olficrr, Delaware, Lackawanna and VW-i'-rn I? u!ici:nl). Mi l '!> m man and g'-nilr men, ymir ('ouimittce on Nominal nti'l M.ii'-li i'.Mli al. ilic Congf-wa Hotel in Chicago uuil th following inr'inliei< were jirc--ui: Dr. B. I. Dornuf, Chief Surgeon, Northern Pacific; Dr. J. W. IL,uk. Medical Director. New York, Chicago tfc St. Lnui-: Dr. R. S Ki.-jf, r. Surgeon. Mi'>ouri-I\.in-n.<-Te\a-<; and Dr. Ray S. U".-ilia.-. Chief Surg-on. B.is Railway Company of Chicago. In Sine '-will >hc Hull- of Older and inking into emj-idcration the alloca tion of nominees for the Committee of Direction, we have selected the fol lowing members for ballot: ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION ANNUAL MEETING--APRIL 2, 1951 BALLOT FOR MEMBERS OF COMMITTEE OF DIRECTION (Indicate by an 'X' the names voted for) Eastern Territory (2 Year Term--Vote for One) Dr. 1. r,..M..'A-kv. M.daal Dit.rlor ( mini i'.uiioad Company of New Jersey Dr V N u : r. t M. .R. d t R<- . 11n r i iir. Dr. B. W. .'I'.'km ii. Cliu-f Surgeon D. T ! d.j Siior-' farm Railroad Southern Territory (3 Year Term--Vote for One) -- Dr. Duncan Kve, Chad Surgeon Na.Miville, Chattanooga & St. Louis Railway Dr. C. K. Holton, Chief Surgeon Central of (Georgia Railway Dr. V. A. Lockwood, Chief Surgeon Florida East Coast Railway iJ 4 4 4 i \ 92 Association of American Railroad* Western Territory <S Year Term*--Vote for Three) Dr. R. M. Graham, Director, Dept. San. ft Surgery The PullmaQ Company Dr. Wm. Hibbitts, Chief Surgeon St. Louis Southwestern Railway Lines Dr. E. A. Hinds. Chief Surgeon Denver A: Rio Grande Western Railroad Dr O. 11. Hurrah, Chief Surgeon Chicago. Burlington A Quincy Railroad I)i A R. Mi ir. ('hn-f Surgeon Chicago. Milwaul.' e, St Pan! A- I'arihe HJt. J li. J K Si art,. ('l, i f Sing" Chit-ago A- Noilh Wi-tr-m Railway Dr. \V. W. Wa-hburn. Chief Surgeon Sou'hern P.v-ifie Con.pane Dk. Davi- : Wo n-iH'-i fully ubm)'. the-.- names to thf membership. The Ohaihmw: Wo will have tho ballots available in just a few minutes. Tus Seou:takv: Gentlemen, in connection with the ballots, it is neces sary that only one man for a railroad--or whatever number of railroads he represents--make out a ballot. If the chief of the department is here, then presumably he will do so unlc-s.* he designates some one else for h railroad. The ballot should be completed as called for and replaced in this envelope. It is necessary that you simply show your name and the name of the railroad or railroads that you repro.-ent (The Chairman then appointed a* tellers, Doctors R. J. Bennett. Jr., Chief Surgeon. Elgin, Joliet k. Eastern Railway; J. F. Depree, Chief Surgeon (Lines West), Chicago. Milwaukee. St. Paul <k Pacific Railroad; and V. W, Hollo, Chief Surgeon, St. Ixmis-S.m Francisco Railway, to count the ballots. At the openipfe'bf the Second Session. Dr. Bennett presented the Report of Tellers, as follow.-): Du, R. J. IUanktt. .In. (Clou Mng<<>n. Klein. Joliet .uni Eastern R:nl wuv): Gentium u. the results of t!> voting Me a follows: Eastern Territory (2 Year Tent: > Dr. I. Goidowsky, Medical Director Central Railroad Company of New Jersey Southern Territory (3 Year Term) Dr. Duncan Eve, Chief Surgeon Nashville. Chattanooga ft Si. Loui- Railway Western Territory (X year Term*) Dr. R. M. Graham, Dim-tor, Department of Sanitation and Surgery' The Pullman Company rship. 4t aecrnrxilroads is here, c for hi? (i in this name of t. .Jr . Iv W port 'H n Rail' Procecdingi of Medical and Surgical Section 93 i Dr. A. R. Met*, Chief Surgeon Chicago, Milwaukee, St. Paul Sc Pacific Railroad - Dr. W. W. Washburn, Chief Surgeon Southern Pacific Company The Chairman: The representatives which have just been named along with the remaining Members of the Committee of Direction will constitute the personnel of that Committee for the coming year. It will now be necessary for this committee to meet in the adjoining room for a few minutes to relict their Chairman aad Vice-Chairman, and there will be a rere.^a for a few mioutos. I will ask Dr. Bennett, Dr. Dowd, Dr. Eve. Dr. Graham, Dr. Hursh, Dr. Mishler, Dr. Wagner, Dr. Goldowsky and Dr. Washburn to meet out here in Room G for just a few minute? to elect your officers. Then tve will be back and we can carry on. (A short recess was taken.) V The Chairman: I might report that Dr. T. L, ffanaen, Chief Surgeon, i Chicago, Rook Island k Pacific Railroad has been made Chairman of the Committee of Direction and Dr. A. M. W. Hursh, Chief Medical Examiner, Pennsylvania Railroad has been elected Vice-Chairman. They will carry on after this meeting is over today. * i 3urgery * Ht c. 94 Auoeiatxon of American Railroada OFFICERS AND PERSONNEL OF 00MMITTEE8 OF THE MEDICAL AND SURGICAL SECTION FOB THE TEAR 1951-1962 Dr. T. L. Hansco, Chairman Dr. A. M. W. Hursh, Vice-Chairman U. S. Drwhnnit, StcTHnry Committee of Direction Dr. T. I.. H.'.n-'Ji Chairman Dr. A. M \Y. lluoli. Yi<ii-C'Jittirni:ui (Term expires in 1952) Dr. M. B. Clayton, Chief Surgeon. Southern Railway System, Washington, D. C. Dr. K. E. Dowd, Chief Medical Officer, Canadian National Railways, Mon treal, Quebec, Canada. Dr. T. L. Hansen, Chief Surgeon, Chicago, Rock Island and Pacific Rail road, Chicago, Illinois. Dr. J. Huber Wagner, Chief Surgeon, Bessemer and Lake Erie Railroad, 1027 Carnegie Bldg., Pittsburgh 19, Pennsylvania. (Term expires in 195.1) Dr. 11. J. Bennett, Jr., Chief Surgeon, Elgin, Joliet & Eastern Railway, 208 South La Salle Street, Chicago, Illinois. Dr. A. M. W. Hursh, Chief Medical Examiner, Pennsylvania Railroad System, 15 North 32nd Street, Philadelphia Pennsylvania. Dr. W. E. Mishler, Chief Surgeon. Erie Railroad, 608 Republic Building, Cleveland I. Ohio. Dr. I. Goldowsky, Medical Director. Central Railroad of New Jersey, Jersey C'iiv, New .li-r-ty. t'lYiiu < in 1951) Dr. Duncan Eve, Chief Surgeon, N'ahville. Chattanooga & St. I.ouis Rail way, Nashville, Tenn. Dr. R. M. Graham, Director, Department of Sanitation and Surgery, The Pullman Company, Chicago, Illinois. Dr. A. R. Met?, Chief Surgeon (Lines East), Chicago, Milwaukee, St. Paul & Pacific Railroad, Chicago, Illinois. Dr. \\ . W . Wa-hburn. Chief Surgeon, Southern Pacific Company, San Fran cisco 17, California. Committee on Disability and Rehabilitation Dr. James K. Slack (Chairman), Chief Surgeon, Chicago A North Western Railway, 127 North Clinton Street, Chicago 6, Illinois. OP THE 1951-1952 1 f V * A- l i i m, Washington, Railways, Mon- ! Pacific RailKr ilroad, .-tern Railway, .mia Railroad ma. iMie Budding. Jcrwy, Jersey t. Louis Rail* Surgery, The kee, St. Paul :y, San Fran- rth Western Proceedinqa of Medical end Sriryical Sedion 95 Dr. J. F. DePreo. Chief Surgeon (Lines West), Chicago, Milwaukee. St. Paul 4 P.infir Rmlnuid, tfl? Mt-ihml Arts Building, Seattle l, Wash ington. Dr. S. M. English. Medical 4 Surgical Director, Room 217 B40 Central Building, Bnltimun' 1, Maryland. Dr. It. S. Kielli-r, Chief Surgeon, MisMiuri-Kans/Lv-Texae Railroad. St. Louis 1, Missouri. Dr. W. W. Wiu-hhorn. Chief Surgeon, Southern Pacific Company, Hospital Dejeirtnu'ni, I4U0 Fell Street, San Francisco 17, California. Committee on Fractures Dr. 11. W. Stovkwi-ii (Chairman), Chief Surgeon, Detroit 4 Toledo Shore Line Railroad. Detroit, Michigan. Dr. Ralph G. Curothera, Chief Surgeon, Cincinnati, New Orleans 4 Texas Pacific Railway, Cincinnati 2, Ohio. Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga 4 St. Louis Rail way, 2001 Hayes Street, Nashville t, Tennessee. Dr. C. F. Holton, Chief Surgeon, Central of Georgia Railway, Savannah, Georgia. Dr. J. ITuher Wagner, Chief Surgeon. Bessemer 4 Lake Erie Railroad. 1027 Carnegie Bldg., Pittsburgh 19, Pennsylvania. Committee on Developments Resulting from Physical Examinations Dr. R. J. Beunett, Jr. (Chairman), Chief Surgeon, Elgin, Joliet 4 Eastern Railway, 203 South La Salle Street. Chicago, Illinois. Dr. J. J. Br:uii).-t!;ur, Chief M.-dicai Examiner, Chesapeake 4 Ohio Ry., Huntington. West Virginia. Dr. 13. 1. Dcrauf, Child Surgeon, Northern Pacific Ry., St. Paul l, Minne sota. Dr. 0. H. fft/rr-il), Clu.-f Sui^eon. Chiivigo, Burlington 4 Quincy Railroad, 517 West Jaeksoa Boulevard, Chicago 0, Illinois. Dr. K. C. Wildt-n, Superiniondeut and Medical Director, Relief Depart ment, Ailantic Coast Liuo Railroad, Wilmington, North Carolina. Dr. R. S. WMtline, Chief Surgeon, Chicago 4 Eastern Illinois Railroad, 334 West t3rd Street, Chicago, Illinois. Committee on Medical Aspects of Air Conditioning of Cars Dr. R. M. Graham (Chairman), Director, Deportment of Sanitation and Surgery. The Pullman Company, Merchandise Mart Plaza, 22 West North Bank Drive, Chicago 54, Illinois. Dr. M. B. Clayton. Chief Surgeon, Southern Railway System, 15th and K Street* N.W., Washington, D. C. Dr. Charles l). Fenwick, Chief of Medical Sendees, Canadian Pacific Rail way, Windsor Station, Quebec, Canada. i j ii I i j j OF THE LB 1051-1952 V m, Washington, Railway*, Monid Pacific Rail- Rr ilroad, .-icna Railway, .inia Railroad -nia. if-tie Budding, ft-rwy, Jor^v !. Louis Rail* Surgery, The kee, St. Paul ;y, San Fran- rth Western Proceeding* of .Medical and Surgical Section 05 Dr. J. F. DePrec, Chief Surgeon (Lines West), Chicago, Milwaukee. St. Pnill A Pneifje Radrmd, 407 Medical Arts Building, Seattle l, Wash ington. Dr. S. M. English, Medical A Surgical Director, Room 217 BAO Central Building, Baltimore 1, Maryland. Dr. K. S. Kirffer, Chief Surgeon. Missouri-KanjHLvTexaa Railroad, St. Louia 1, Missouri. Dr. W. \V. Wa>hburn. C'liief Surgeon, Southern Pacific Company, Hospital Department, Muo Fell Struct, San Francisco 17, California. Committee on Fractures Dr. B. W. Stockwell (Chairman), Chief Surgeon, Detroit A Toledo Shore Line Railroad. Detroit, Michigan. Dr. Ralph 0. Carothers, Chief Surgeon, Cincinnati, New Orleans A Texas Pacific Railway, Cincinnati 2, Ohio. Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga A St. Louis Rail way, 2001 Hayes Street, Nashville 4, Tennessee. Dr. C. F. Holton, Chief Surgeon, Central of Georgia Railway, Savannah, Georgia. Dr. J. Huber Wagner, Chief Surgeon, Bessemer A Lake Erie Railroad, 1027 Carnegie Bldg., Pittsburgh IS, Pennsylvania. Committee on Developments Resulting from Physical Examinations Dr. R. J. Bennett, Jr. (Chairman), Chief Surgeon, Elgin, Joliet A Eastern Railway, 203 South La Salle Street, Chicago, Illinois. Dr. J. J. Urundabur, Chief Medical Examiner, Chesapeake A Ohio Ry., Huntington, West Virginia. Dr. 1). L Derauf, Chief Surgeon, Northern Pacific Ry., 3t. Paul 1, Minne sota. Dr. O. ff. lb>rnH, rhi.-j Surgeon, Cluertgo, Burlington A Quincy Railroad, 547 West J-irk<oo Boulevard, Chicago 6, Illinois. Dr. K. ('. Walden, Superintendent and Medical Director, Relief Depart ment, Atlantic Coast Line Railroad, Wilmington, North Carolina. Dr. R. S. West line, Chief Surgeon, Chicago A Eastern Illinois Railroad, 3S4 West u3rd Street, Chicago, Illinois. Committee on Medical Aspects of Air Conditioning of Cars Dr. R. M. Graham (Chairman), Director, Department of Sanitation and Surgery, The Pullman Company, Merchandise Mart Plaza, 22 West North Bank Drive, Chicago 54, Illinois. Dr. M. B. Clayton, Chief Surgeon, Southern Railway System, 15th and K Streets N.W., Washington, D. C. Dr. Charles B. Fenwick, Chief of Medical Sendees, Canadian Pacific Rail* way, Windsor Station, Quebec, Canada. * j i ! I j i i J 90 Aitoeiaiion of American Railroad* Representatives 0/ the Medics! sad Snrgtcs! Section on the Joint Committee on Railway Sanitation Dr. K. M (iutlium. Director, Department of Sanitation and Surgery, The Pullman Company, Chicago. Illinois. Dr. M. B. Clayton, Chic/ Surgeon, Southern Railway System, Washington, D. C. Dr. A. M. W. Hurnli, Chief Medical Examiner, Pennsylvania Railroad, Philadelphia, Penneyjvunia