Document jm4nnQy698RojG2o9g1LDROpQ

HE 275 A5I Afl M ! 1952 <' ' A A'W' ,V /yC.; -- S. . ."V'" ,,t -;?y| v- J Association of American Railroads <-' ''$ , <`r >**>** PROCEEDINGS oi mi THIRTY-SECOND ANNUAL MEETING OF THE MEDICAL AND SURGICAL SECTION S' i p FED-9" i'53 ^ OBUAHv CHICAGO, ILLINOIS MARCH 31, 1952 ::, ^ ; ., t , i#Sj * *t .* `-ny j vie- i . - | i . . . ->,. . .*< PLAINTIFF'S EXHIBIT .. PROCEEDINGS OF THE THIRTY-SECOND ANNUAL MEETING OF THE Association of American Railroads MEDICAL AND SURGICAL SECTION >tx-V- ii.-. V/, -- VT -t* fnr. HELD AT THE DRAKE HOTEL CHICAGO, ILLINOIS MARCH 31, 1952 Association of Amcri' Board of DirectOffu-ors .......... Ofa-ratitms un<l OfxT.-ituiK-Truft- Bennett. Richard J.. rucnl> Itt-Hij111' Committee of Dirwcti Committee on LVvdReport of ......... Committee on Disah Report of ....... Committee on Medi- Committee on Nome Committee on Traun Report of_____ First Aid Equipment Graham, U. M.: Itcj Sanitation Re Hansen, T. L.: Addr Medical and Sur^ieOfficers of Sect i Officers of SectiElection of Men Election of Cha: Representatives RuIor of Order INDEX Association nf American Railroads: Board .(' I Jirci-tors .. .. Ollieors ... Operations and Maintenance lYpartnient 0|Kiratmg-Tmn.i[*>rt.alinn Division Olfnvr* Page ....... ................ 5 .... ................. 6 ft Bennett, Richard J., Jr.: presenting Report of Committee on Develop ments Resulting from Physical Examinations.......... .............. 51-64 Committee of Direction...............__...................................... ...................... 6 Committee on Developments Resulting fromPhysical Examinations.. 7 Report of ..... _................................................... ..................... 51-63 Committee on Disability .uni Rehabilitation Report of...................................................... ... .......................... 7 18-42 Committee on Medical Aspects of \ir Conditioning of Cars.... Committee nit ,\'nm*iati<>n.s. Report of 7 67-0'.) ('nmmittee on Trauma Report of 7 15 l`) I' i: -l V.d ! - iiliji. ii- n I nut I-1; - I \,d In-' ri|i I cm-. !, -ru.--ji'U of 0 t. 05 tlrahum, R. M.; R<-por< in Medical .md SuighMi S.-rlim* on t.A.R. Sanitation Rc-carch uid Development Id. II Hansen, T. L: Address as Chairman Mi, 17 Medical anil Surgical Section: Otficors of Scctwm and Personnel of ('amimltivK P.J51 l'.l:V2 t> H Olficera of Section and Personnel of Comuuttis-s P.)52-15)53...... . 70, 71 Election of Members to Committee of Direction . ........................ 68, 69 Election of Chairman and Vice-Chairman....... ..............................65, 66, 69 Representatives attending Annual Meeting.... .......... ....................... 13-15 Rules of Order....... ......................................... .. ................................... 9-12 iii Mi.cki'i'll, I'. H : j>ri i ii:j: I < < | k 11 ni (`miiiiiii (* on Tran in:. I"- l`i v. iv ASSOCi W. T. Karicy, J. Carter Fort J. II. Aydoloi Waller J. K! Vuluat n-i. J. II. Panin 1 Hubert S. Hei. Ci. M. Campl. W. T. Fwirv, V. Md>. I).t\ Hnrrv A. U.-l J. J>. I'arrii.j:Waller*. i-1.. V. 0. Gurl,y Tojvkii \ C. M. HuUl,!: J-. W. JollDsli W. A. Johnev J. P. Kilcy, Pi G. Metzraan, H. C. Murph> T. J. Neff, Cl. D. J. Ruseell, Joho W. Smiti A. E. Sioddar. Hoy B. White Wm. White, I 0/ H ASSOCIATION OF AMERICAN RAILROADS i6 (April, 1952) :,0 .'.0 ---41) Officers W. T. Faricy, President. J. Carter Fort, Vice-President and General Counsel (Law Department). J. H. Aydelott, Vico-Prefident (Operations and Maintenance Deportment). Walter J. Kelly, Vice-President (Traffic Department). ........................................ We-president (Finance, Aciiumtmg. Taxation and Valuation Department). J. II. Parmvloe, Vico-President and Director (Bureau of Railway Kcunomics). UobortS. Henry, Vice-President (Public Relations Department). Cl. M. Campbell, .Secretary-Treasurer. Board of Directors W. T. Far:-y. Chairman x-uirx i<A. iM D. Pr. -:(> nt, Vil.citic I '<<a.-t l.me I!.,dp :!. Harry A. Dellutis, I'n-nd.-m, Southern Railway sy.:. in. J. I). Farrington, Pn-*:dw.. Chicago. Ibx-k I-I.iad .t I' ific R ulm.id. Wallor.S. Franklin, Pc-ideut, Peun.-yleania Railroad. F. G. Gurley, President and Chairman of Executive Gommittee, Atchison, Ti>|X'lfa <fc .Santa Fe Railway. C. M. Hutchins, President, Bangor it Aroostook Railroad, p. \V. Johnston, President, Frio Railroad. \V. A. Johnston, President, lilmow (.'entail Railroad. J. P. Kiley, President, Chicago, Milwaukee, St. Paul * Pacific Railroad. G. Metznun, President, Now York Central System. H. G. Murphy, President, ('lilcago, ihirliiintoii t l^uincy Railroad. P. J. Neff, Chief Rwcutive Ullieer, Missouri Pacific Line*. D. J. Russell, President, Southern Pacific Company, John VV. Smith, President, Seaboard Air Line Railroad. A. K. Stoddard, President, Cnion Pacific Railroad. Roy Jl. White, President, Maltimnre & Ohio Railroad. Win. White, President, Delaware, foukuwaima <k Western Railroad. 5 4**.".WW 1 xuj -.1 fr rz^Jissa-- --rt --i- j 6 Aatocialion of American Railroad* A i OPERATIONS AND MAINTENANCE DEPARTMENT i J. H. Aydelott, Vice-President OPERATING-TRANSPORTATION DIVISION F. A. Dawson, Chairman R. C. Pursons, Vice-Chairman L. R. Knott, Executive Vice-Chairman OFFICERS AND PERSONNEL OF COMMITTEES OF THE MEDICAL AND SUKC'lCAL SECTION FOR THE YEAR 1951-1962 Dr. T. I.. IlaiiM ji, Chairman Dr. A. M. W. Hur?!i. Vice-Chairman II. S. Devvhursl, Sven tary iJ? Committee of Direction Dr. T. L. Hansen, Chairman Dr. A. M. W. Hursh, Yjee-Ohainnun (Term expires in 1952) Dr. M. B. Clayton, Cliief Surgeon, Southern Railwav System, Washington, D. C. Dr. K. E. Dowd, Chief Medical Officer, Canadian National Railways, Mon treal, Quebec, Canada. Dr. T. L. Hansen, Cliief Surgeon, Chicago. Rock Island and Pacific Railroad, Chicago, Illinois. Dr. J. Huber Wagner, Chief Surgeon, Ik-sscmer and I-akc Erie Railroad, 525 William I'enn PL, Pittsburgh, Pennsylvania. (Term expires in 1953' Dr. R. J. Bennett, Jr., Chief Surgeon, Elgin, Joliet & Eastern Railway, 20S South Igi Salle Street, Chicago, Illinois. Dr. J. (eildowsky, Medical Direrlor, C-enlral Railroad Company of New JeiM-v, Jfcisey Cil \ i New Dr. A. M. W. 1 lursli. Chief Medical Evanm'-i, IVnn.-x Ivama RailroadSysleiu, 15 \<nlh 15`Jnd Street. I')>ilade!)!>>.. !, I Vnn.-vlv:Uii:i. Dr. V.. L. Mi-l.Ui. Chef Surg-wii, l.ue U-.ulimel. (>US Republic Uuildmg, Cle\ eland 1. Ohio- (Term expires in 1954 Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga & St. Louis Railway, Nashville, TenD. Dr. R. M. Graham, Director, Department of Medicine and Sanitation, The Ihillman Company, Chicago, Illinois. Dr. A. R. Met/., Chief Surgeon (Lines East), Chicago, Mihvauk-o, St. Paul A Pacific Railroad, Chicago, Illinois. . Dr. W. W. Washburn, Chief Surgeon, Southern Pacific Company, San Fran cisco 17, California. (Retired effective February 1, 1952.) l Dr. J Dr. J i Dr. $ 1 Dr. I Dr. V Dr. IL Dr. 1 1 Dr. L 2 Dr. ( C Dr. J h C Dr. 1 I Dr. J I. Dr. B Dr. i Dr. h Dr. ! Dr. 1 S N Dr. h S Dr. C Y ' Proceedings of Medical and Surgical Section 7 Committee on Disability and Rehabilitation Dr. .JurncH K. Stack (Chairman), Chief Surgonn, Chicago A North Western Railway, 127 North Clinton Street. Chicago >, Illinois, Dr. J. F. DeProc, Chief Surgeon (Line* West), ('hieago, Milwaukee, St. Paul & Piu-ific Railroad, 107 Medical Aria Building, Seattle I, Wo-shingLon. Dr. S. M. English, Medical A Surgical Director, Room 217 BAO Central Building, Baltimore l, Maryland. Dr. R. S. Kieffer, Chief Surgeon, MUs-mri-Kansas-Texas Railroad. St. Louis 1. Missouri. Dr. W. W. Washburu, Chief Surgeon. Southern Pacific Company, Hospital Department, 1100 Fell Street, San Francisco 17, California. Committee on Trauma Dr. B. W. Stockwell (Cliairman), Chief Surgeon, Detroit & Toledo Shore Line Railroad, Detroit, Michigan. Dr. Ralph G. Carothers, Chief Surgeon, Cincinnati, New Orleans & Texas Pacific Railway, Cincinnati 2, Ohio. Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga A St. Louis Railway, 2001 Hayes Street, N:ulivUle 4, Tonness^. Dr. C. F. Holton. Chief Surgeon. Central <>f Georgia Railway, Savannah, Georgia. Dr. J. HuIkt Wagin r, Chief Surgs>n, Bessemer A f-ake Erie Railroad, Pitts burgh, Pennsylvania. Committee on Developments Resulting from Physical Examinations Dr. R. .1. Bennett. Jr. 'Chairman), Clnef Surgeon, Elgin, Juliet A Eastern Kail.vaj , JO'S Su'iih ! ,i S ill-- St n et, ( 'hjcig.Illinois. Dr. J. J. Brandahur. Chief Medieal I.'xamiiier, < 'heetpeake A Oliio Ry., Huntington, \\V-t Virginia. Dr. B. I. Derauf, Chief Surgeon, Northern Pacific Ry,, St. l*aul I. Minnesota. Dr. O. H. Horrall, Chief Surgeon, Chicago, Burlington & Quinry Railroad, 547 West Jackson Boulevard, Chicago 6, Illinois. Dr. K. C. Walden, Su|K>riuteiident and Medical Director, Relief Department, Atlantic ('oast Line Railroad, Wilmington. North Carolina. Dr. R. S. Westime, Chief Surgeon, Chicago A Eastern Illinois Railroad, 334 West 63rd Street, Chicago, Illinois. Committee on Medics! Aspects of Air Conditioning of Cars Dr. R. M. Graham (Chairman), Director, Department of Medicine and Sanitation, The Pullman Company, Merchandise Mart Plaza, 222 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 Services, Canadian Pacific Railway, Windsor Station, Montreal, Quebec, Cauada. 8 Association of American Railroad* Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation Dr. R. M. Graham (Chairman), Director, Department of Medicine and Sanitation, The lhjilman Company, Chicago, Illinois. Dr. M. B. Clayton, Chief Surgeon, Southern Railway System, Washington, D. C. Dr. A. M. W. Hursh. Chief Medieul Kxainimr, Pennsylvania Railroad. Philach Iphia, Pennsylvania. u ASSO 1. REPR r'-pn- -nt.-.r Chief .Surg Kxjitvsa Ag in this Sect 2. AFFIl collahoratii. beT thereof tion. An n member ron 3. The of; and Secrctar (a) As VICE-CH. , its memhi not aUCeee (ll The . the 1 ivimh approval . (el The lertii.'t i.tll Kiichind from the V for three > The ten. ; shall rxpir ` conuuitb'v until the n In aildn Bureau of him, and ; I and Provii | members e i i I' ProewlitKjs oj \f"Uc/il and .'turqiad Stdion 9 Association of American railroads OPERATING TRANSPORTATION DIVISION MEDICAL AND SURGICAL SECTION n iw ^ t.--------- v . - a f i , ' - _____ ,________________ r ^ RULES OF ORDER 1. REPRESENTATION: As provided in tin* Han of Organization, the representation of memljer roads in .the Medical ami Surreal Section shall be Chief Surgeons or other persons engag'-d in a similar capacity. The; Railway Express Agency, Inc., ami the Pullman ('lunpany are eligible for membership in this Sectioo. 2. AFFILIATED MEMBERS: A representative of an organization collaborating or cooperating with the Section may become an alfiliated mem ber thereof upon the approval of his application by the Committee of Direc tion. An affiliated im-mlier shall have tin- rights .ml privileges accorded a member road representative, except voting or tin* holding of office. Officers and Committees 3. The officers of the Section shall cnn.si.st of a Chairman, Vi.... Chairman ami Secretary. (a! As provided m ihc I I m <u l >i g > m<al mil. lie- CHAIRMAN and VICE-CIIAfRMAN half ! rJ I.\ I,.- ( '<>iooo< >. <*f I >nr< i n>u fi**m i Is member- hip. Th-ii i*r n. ..f 't h ill !< !.< . .r \ t 1, i r < ui a ill not -uceislinns* ji bi The SECRETARY a ill be jj.pmnr *1 i.v if..- C. ic ial Committee of the I hvidori. If is -il.irv -Ini! r* mird !*y lb P ' .iiin.o '*. -ob Vet ro the approval of the Viec-l'ivsideii'. iljjcnliniis :iin| M-.m:* nairn* I )epaM amit. (c) The COMMITTEE OF DIRECTION will ,-onsi.st of twelve meml^-rs, territorially representative as far n practicable--one <a`h from NY-.v England and Canada: four fr**m the Ki-t; two from the South and four from the West--elected as hereinafter pn -<nlwd, each of whom shall serve for three ) ears. The terms of office of all elective members of the Committee of Direction shall expire at the conclusion of the annual meeting. Vacancies in the committee membership shall lie filled by appointment of the Committee until the next election. In addition to the above, the Surgeon-General of the United State* 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. 10 Auocialum of American Railroadt The Committee of Direction will select from its elective membership a Chairman and Vice-Chairman of the Section, whose terms of office shall be one year. A Chairman will not succeed himself. (d) The Standing Committees of the Section will be as follows: Committee on Disability and Rehabilitation Committee on Trauma Committee on Developments Resulting from Physical Examina tions Committee on Medical Aspects of Air Conditioning of Cars. The representation of member roads on these committees will be, so far as is practicable, territorially selected, in approximately the same pro portions as that of the Committee of Direction, personnel u> be named each year by the Committee of Direction immediately following adjourn ment of the annual meeting. Duties of Officers 4. The CHAIRMAN shall have general sujjervision over the aflairs of the Section and shall preside at meetings of the Section and at meetings of the Committee of Direction. 5. The VICE-CHAIRMAN, in the alwcnec of the Chairman, shall perform the duties of the Chairman and such other duties as may be assigned. 6. (a) The SECRETARY shall perform the usual duties of that office and such other duties as may be assigned to him hy the Chairman. (b) He shall receive six weeks in advance of the annual meeting each year the report of the Committee on Nominations, as elsewhere provided for, and will submit to ihe membership at the annual meeting the nomina tions contained in that report, to dll the vacancies in the membership of the Committee of Direction. He shall announce the result of the election promptly to the members. Duties of Committees 7. The COMMITTEE OF DIRECTION shall: (a) Exercise general supervision over the interests and affairs of the Section. (b) Be empowered to act on behalf of the Section in the interim between meetings and shall submit at Curb meeting a report covering its actions. (c) Examine and decide what portion of communications, papers and reports shall be submitted at the meeting-. It 6hall determine which, if any, of the subjects presented by the various committees, shall be referred to the General Committee of the Division. (d) Appoint two months in advance of the annual meeting each year a Committee on Nominations, consisting of representatives of five member roads, who shall not be members of the Committee of Direction. (e) Appoint additional committees as required. (0 Submit to the Chairman, General Committee, detail of con templated financial requirements for conducting the work of the Section as required or as called for by that official. (g) Call annual meetings of the Section, subject to the approval of the General Committee of the Division, if in its judgment conditions warrant. membership office shall ows: d Examine- g of Cars. ;fl be, so far j same pro> be named :ig adjourn- (Taire of the tings of the tali perform od. t of. i ting each re provided :he noraiaambership of the electioo f.nrs of the un between its actions, papers and ,e which, if he referred each year a ve member il of con.he Section oval of the s warrant. . Proceedings of Medical and Surgical Section 11 (h) Cali meetings of the Section, upon not less than thirty days' notice to each member. It must call special meetings of the Section upon the request, in writing, of a majority of the member roads. 8. The COMMITTEE ON NOMINATIONS, appointed as above prescribed, ahull report 1.0 the Secretary at least six weeks in advance of the annual meet ing of each year, at least two nominations for each impending vacancy to re place the four members of the Committee of Direction whose terms expire that year, and to fill any vacancy. The duties of the Standing Committees hall he aa follows: 9. COMMITTEE VO. I--The COMMITTEE ON DISABILITY AND REHABILITATION shall study and report, with suggestions or recommenda tions, on such subjects that have to do with the physical efficiency or ineffi ciency of railroad employee. It shall also consider ways aad means for the rehabilitation of injured or incapacitated employes and the complete restora tion of function. I 10. COMMITTEE NO. 2--THE COMMITTEE ON TRAUMA shall I study and report on the treatment and transportation of fracture cases includ ing (a) Diagnosis of fractures, (b) First aid and transportation splints, (c) Fracture report forms, (d) X-ray work in connection with fractures, and similar subjects. U. COMMITTEE NO. 3--The COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS shall analyze and make report, with recommendations or suggestions, on data made available by periodic examinations, etc. It shall study and revise as conditions may warrant, the recommended standards covering physical examinations as well as tiie forms u.scd in connection therewith. 12. COMMITTEE .VO. 4-i'he COMMITTEE ON MEDICAL ASPECTS Of AIR CONDITIONING OF CARS shall study and report oil this subject in its relation r<> the heaith 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 mil call or by ballot. Each member road shall be entitled to one vote. The vote of the majority of the member roads represented shall be required to decide any question, motion or resolution, unless otherwise ordered, (b) Voting for candidates for membership on the Committee of Direction shall be by ballot, (c) Unless otherwise designated by it, the ranking officer will be recognized us 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 most be taken on ail questions affecting physical property. The voting power of the member roads shall be proportionate to the ownership of miles of road. 12 A XHocisition of Ammcnn Uatfmnt!* 15. ORDER OF BUSINESS: The order of business at meetings of the Section shall, unless otherwise directed by a majority of the members present, be as follows: Approval of minutes of last meeting Reports of .Standing Committees Hearts of Special Committee Kcjjorls of Tellers Unfinished Bin-mess New It'lMiif 1G. iG/iicil's iiale-. of onln I govi'm tl,e proceeding' nf i]u> Section, including .ifin*:<i 1 ;i,t to tin- *- R il--'- of Or.). ;. ;v . :? a Drake Hotel. Cl. Men. Atchison, Topeka A Baltimore & Ohio Railroad..... ...... Baltimore & Ohio i: Bangor & Aroostoo! Belt Railway Com; Bessemer & Lake L Boston 4 Maine ll:<. Canadian National Canadian Pacific U. Central of Georgia i Central Railroad ( Jcrw y Central Win."M R Chicago A UaM'-rn ! Chicago A* North \\ Chicago Western Chicago, Milwaukee Railroad....... ....... it mooting* of the e members present. _'s ..f tlii> Section t t I'roceedinys of Medical and Surgical Section 13 i ASSOCIATION OF AMERICAN RAILROADS r e MEDICAL AND SURGICAL SECTION i Drake Motel, ('hwago, Illinois, M:\rvh 31, 1M.Y2, Tin- following were present: Members Representatives Atrbison, Ti>i>cka & Santa Ke Railway Dr. .1. R. Winston, .System Medical Director. Baltimore <fc Ohio Chicago Terminal Railroad..... ....................... ............ Dr. 3. M. Kngiish, Medical and Surgical Director. i li.i(Uiii'>iv <>!uo Railroad Dr. S. M. KngLsh, M-'tli.al anil Surgtc il 1 'irci'tor. i Bangor iV \roo-took Radio n) . Dr. II. {'. Bundy, Chief Surgeon. Belt Railway Company of Chicago Dr. It. S. U i stline. Chief Surgeon. Bi-sst'iu-T itiki- Kn>- Railroad I >r. J. IIijIut Wagner. Chief Surgeon. I tii*i. .it .V M.mi*1 I! uli-> . I -iii . i: m \ i (I K -o! .v i\ * liv. .i. If Kt.ow h-, t 'hiet Surgeon. I >' K. 1C 1 Inw.l. i \|,.,ti. ,| < t * I II I' I>'lII P i' ll|C If III'VII v Dl c I* I-'- l'\\ id* , Chief of Scl \ |. . .. Dr. <1. I ole Wight, D:*ini | ' Mie.-r. >| f ij a ' cigi.t I ,'.m . i_v Dr. <'. I. Moll (in. ( hn-j Surgeon, Central Uailro:ul Company of New 'b,r*',y. Dr. Ira (io|itoa*hy. Medical Director. Central Vermont Railway Dr. K. K. Dowd. I 'hu-| Medical Ollicer. Chicago A Eastern Illinois Railroad... .Dr. R. S. WcstlUie, Chief Surgeon. Chicago 4 North Western Railway .. Dr. J. K. Stack, Chief Surgeon. Dr. \V. II. Longworth, District Sur geon. Chicago 4 Western Indiana Railroad Dr. R. 3. Westline, Chief Surgeon. Chicago, Milwaukee, St. Raul 4 Pacific Railroad...... ..... ................................. Dr. Raymond Householder, Chief Surgeon (Lines Blast). Dr. J. F. DePrce, Chief Surgeon, (Lines West). Dr. W. H. Longworth, Local Surgeon. ki.*i i C'i f vrv.i n n lirfiiWa '~w.s 14 Association of American Railroads Members Representatives Chicago, Rock Island 4 Pacific Rail road-...................................................... Dr. T. L. Hansen, Chief Surgeon. Cincinnati, New Orleans & Texas Pacific Railway....... ............................ Dr. R. G. Carothers, Chief Surgeon. Cleveland, Cincinnati, Chicago 4 St. Louis Railway _...................................Dr. Win. II. Norimin, Chief Surgeon. Colorado 4 Southern Railway Dr. W. J. I/mgewny, Chief Surgeon. Delaware. I,:n kauuiiiiu <t- \h".|>-in Railroad Di. Wm. T. Dnvi.-. <'luef Mcdiral ( )ll|i e| . Denver 4: Rio (Ji.imh- Wr -n rn Rail road......... Dr. Ervin Hinds, Chief Surgeon. Detroit 4 Toledo Shore l.me R v!iii.nd Di. R. W. Slocl.well, Chief Sing< mi. Join.! 4 ! Erie Railroad i n Railway ... 1 >i. R. J. R<uu.i ft, Chit f Sing* "O. . Dr. W. K. Mi.diler, Chief Surgeon. Fort Dodge, Dei Monies 4 Southern Railway...............................................Dr. W. H. Longwortli, Chief Surgeon. Grand Trunk Western Railway...........Dr. K. E. Dowd. Chief Medical Officer. Dr. B. \V. Stockwell, Chief Surgeon. Great Northern Railway.......................Dr. R. C. Webb, Chief Surgeon. Indianapolis Union Railway .................Dr. Win. II. Norman, Chief Surgeon. Maine Central Kuiiroad ...................... Dr. J. R. Knowles, Chief Surgeon. Miasouri-Kansas-Texas Railroad_____ Dr. R. S. Kieffer, Chief Surgeon. Dr. W. A. Bowereox, Division Surgeon. Missouri Pacific Railroad ......................Dr. J. A. Lcmlxvk, Missouri Pacific Hospital Association. New York Central System................... Dr. Wm. II. Norman, Chief Surgeon. Dr. C. H. O'Donnell, Medical Dirce- , tor. New York, Chicago 4 St. Duns Rail road......... ............................ ..... .Dr. J. W. Houk, Medical Director. Norfolk 4 W>- n-rij Railway I )i M. E Toplmm. Mediml Dm-etor. Northern Railway Di. R I. Derauf, <'luef Surgeon. Pennsylvania Railroad. Di. A. M. W. Ilur.-li, Chief Medteul I ixaniiner. Mr. V. K. Atuxpuclier, Chief Chemist. Dr* D. liny Murdoex, Surgeon. Pullman Company................................. Dr. R. M. Graham, Director, Depart ment of Medicine and Sanitation. Dr. L. M. Marklej, Chief Medical Examiner. Reading Company........ .Dr. A. Neupauer, Chief Medical j Officer. St. Louis-San Francisco Railway........ Dr. V. W. Hollo, Chief Surgeon. St. LouisSouthwesternRailway ...........Dr. William Hibbitts, Chief Surgeon. y. *1 & & & T< Id Id \. W A* i es l Surgeon. .1' ; r-:i. _<ft. *c/ Medical irgeon. fSurgeon, urgenn. urgeon. ef 2>, .il Oi... er. Nirgi-on. J Surgeon. irgeon. g<i'n. i! Surgeon, nn r.n ifir : ''ii -n. .. >1 I-.,-- iicetor. Director. -icon. f Medical f Chemist, on. r, Departutatioo. : Medical Medical >n. 3urg. S'; Proceedings of Medical and Surgical Section 15 Members Sdo I.iiu- K.ulrn.uj . . Southern I'n' llir ('iilll|uiiy Southern Ihuhvay System TVvtW Mexican Railway 1 '(non I'ai lfie K.idiund I'nioil Railroad.................. Virginian Railway............. Wabash Railroad............... Representstires Dr. Harvey Nelson, Chief Surgeon. Dr. W. \V. Wuslihurn. Chief Surgeon. I)r. J. U. Gandy, Chief Surgeon. Dr. M. II. Clayton, Chief Surgeon. Dr. S. If. Graham, Chief Surgeon. Dr. W. G. Springer, Surgeon Dr. J. Huber Wagner, Chief Surgeon. Dr. Southgate Leigh, Jr., Chief Sur geon. Mr. W. E. Gollings, Superintendent, Wabash Employes Hospitals. Also Present Association of American Railroads....... H. 3. Dewhurst, Secretory, Medical and Surgical Section. I i t 16 Association of American Railroads FIRST SESSION Monday Morning, March 31, 1952 The Thirty-second Annual Meeting of the Medical and Surgical Section, Association of American Railroads, convened at 9:30 o'clock at the Drake Hotel, Chicago, Illinois, Chairman T. L. Hansen, Chief Surgeon, Chicago, Rock Island and Pacific Railroad, presiding. The Chairman': I would like to call the meeting to order. This is the thirty-second meeting of this Section since its inception. I want to welcome :U of v*<. old tif mitei SVe ojx'rially want to wvl- c 'in.- (In: new i> i"nniog in tie- \v.v, iiiei io roll oijl. (he pin.-h e.-ir( l for lie oi. Tie iv lin\t l,e> ii .-omt rh n,gi\* m the pi ^.itiin 1 of oiir nionibordnp since t.i -1 vi ru . S- >:u. of o:ir in. , , n t n. .J Dr. Metz. Coief Surge.,!, oi iJ,< .Milwaukee, retired a* of February 1st of this ye..r. 3>r. Zrtm il <.( lie- M. ---un I'a' jjjr /viin-d ns i>f July 1st of laM year. J h. llirsehti, Id. ( hi'd Smgi <n (la So,, Liijf, ret ii'-d nx of May 1st of last V <: . Among our new members, Dr. Raymond IJuuwhuldet follows the footsteps of Dr. Metz for the Milwaukee Hoad. Dr. Harvey Nelson of Minneapolis fills the vacant y left by Dr. Ihrsclifidd ou the Soo Line. The Santa Fe baa ap]>ointcd Dr. W'iustou, of Temple, Texas, as Chief Surgeon as of about a month and a hall ago. To the best of mj knowledge, those are the changes that, have taken place since last year. If there are some others with which j ou are familiar, l will be very glad to hear about them. Last year, during the chairmanship of Dr. Metz, he mentioned in his remarks the history of the Association, its tutudiou and purpose, and also listed the chairmen and places of meeting for each year, from the time of the inception of this organization. Also, last year, during bis administration, there was a groat deal of work done in bringing up to date some of the work that lias been carried on, especially that covered by the Committee on Disability and Rehabilitation, also the Committee ou Developments Resulting from Physical Examinations. In revising the reports of the Committee on Disability and Rehabilitation, all the previous reports made at the annual meetings were considered and gone over with a fim-tooth comb, and ail reroiuineiidatiniih of the .Section were brought up daii , in ihi- pm.v- ilmgy of ia-l vr,ir`> luoit.ing \mi will find <wri vthing In. ugh I up Io ii ,lc will, ii fi Jrii-v lo (in- j, ur ii w tint, lln-y were pi* p.in d. Tiii- * ofitinni,-r uti Dc\rtojiiui'iil.-, Rr.-uHjng fiom J'Lysnal Lxu.11<ii.111 11-> ai- bioiigiit everything Up to date. Tin-iv waf a p rin l when, on account of tin; war, there were no imeting.x, when tliu.se reports kind of fell by the wayside; that is, they were behind with them: all that w;p brought up to date. Most of you did not see these reports until the meeting of last year, and you did not have time to examine them or think about them in such a way that you could really anal} zc and realize what they mean. I hope that during this post year you have had time to examine them rather earofully, to see how they apply t>> your uvu railroads. We Would like to have a very free discussion and opinion on all of these mutters. ction, Drake lU'.'tgO. 1 want -> wel<-1 for since if this year, if lost tutep >o!is i::l3 >)Ut & place . ill be narks l (In1 ...IM-l Proceedings of Medical and Surgical Sedion 17 First aid is again becoming a warm subject; a number of the states are qow beginning to give consideration to the kind of laws they should pass for the requirements of first aid equipment, so that is again becoming active. The committees are constantly working, trying to keep up to date with the advancements in medicine. Not too much has developed this last year, but what hug developed will be brought up at this meeting. I think that .-aims up the situation to tin* present time. Now we will start in on the program a* it is on the schedule. Fust is the report of the CommiUre on l)i .ability and Itelt.ibdilatii.n, by I Jr. ./au.<-s Iv. Stack, chairman. I Ht. .1 \mks K. K (('lm;f Surgeon, CJne.igo and .North \Waieru Kailway) We had one mowing during the year, and decided--as Dr. Hanson has said-- that since we wi-nt over the Report of tiic Committee oq Disability and Rehabilitation rather cursorily Last year, wc could expect and would appreciate comments now that you have had a year to study it. It is the feeling of the Committee that a report of this kind need not be altered in any significant way each year, and therefore the report of the Com mittee this year differs in no way from the report thut you have in your band now. We will try and be glad to answer any questions, however, that you may have in regard to this report. (For ready reference, Circular No. Mi5-291, Report of Committee on Disability and Rehabilitation dated January 26, 1051, is reprinted here, as follows. The page numbers shown in the iimex at the end of the report refer to those in the p-port .is issued :is a separate circular. The subjects listed iu this Re|x>rt and (In: recommendations `>u b--h.df of t.ho Section shown under each heading were further reviewed with the general discussion being off the record.) idly > 'he hou, gone were fiud 1 i i I 18 Association 0/ American Railroad* (Circular No- M 4 S-2V1) ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION Committee Members Dr. J.-n-f* K. fr-nick (C'li(tirt<.ni<). Clmf h*u>ri-.-i,. Client! 4. North ttiviim lOul- Dr. T. I Dr......... <(...( J* urc> -,ii. ri.ruy:, hurl. I.iuixla 111.,11.mil Dr \V \\ U.i.f IlIuK-in CV1.U..1 fi -l' r... Dr. \\. V, . V hV,l urn. Cl.i" ) r`-,:rc'-i.ii, lioapitil Departiucnt, bouUiern l'cibo Con.|ii.ii.v. Dr. O It. /in.1 rt. CbiW tiurgcuii. MuiM/iiri Detibc Kaitrokd. Adritorr Member* Dr. H. J. Deunett. Jr., CLicf t-urjeon, Elgin, Ji.liet 4 Earit-rn Jtily Di It M. Cifnl.niii. Diririnr. Drpurtn.rnt of Kn,ttMi(>ii 4 Kurgi-ry. 'I be Pullrnan Coin* Di C C* Oily, Cliir) lif hnryrry. CbtOHgo ii*l>iti.[. Illiimlr. (Vnlri.1 )(i.,h call. I>r. () 11 Jii.rrull, Cbt*f S ..rycou. Cbicagu, l'urHnpluli 4 Wulhcv itnilrond Dr. K. o. Kepner. Chief Medical Offioer, Chicago Buriingtvo 4 Qmiicv Hailroaii. Dr A. It Met* (ei-ottici'-i. Chief fcu|ooi itjure l.uM). Chicago, Milwaukee, fat Pul : PaoiSo Railroad. Chicago 6, 111., January 28, 1851. To the Medical and Surgical Section: Your Committee on Disability und Rehabilitation respectfully submits as its report u "Digest" of subjects considered by the Committee in past years and discussed at various Annual Meetings of the Section. This "Digest'' includes a summary of uj>-tn-diite reeimuicudntins or wmmcnU under each subject and the subjects urr listed in alphalx lira! order. There is also an index at th conclusion of the "Digest" which not only lists the names of the subjects with appropriate cross references but indicates the years in which each subject was previously considered by your Committee. As a mutter of record, the original Committee was appointed in 1921 as "Committee on Prevention and Control of Occupational Diseases and Hazards." Reports were published in 1923 and 1924. In 1925 the name of the Committee appears in the Proceedings of the Medical and Surgical Section as tiie "Cnmiinttee on Occupatmnul Discuses und llnzurds." RcjKirts appeared annually from 1925 to 1031, inclusive. lu 1932 the Committee iva culled the "Committee on Occupational Diseases and Rehabilitation," am] in 1933, tins name whs changed to the "Committee on Di.'iliihlv und Rchabihiuimn," uml'T which name it has continued to the jiriM-ol tune. No n-poii-. wcie made m 1938, lUI2-43-t l-L, und 1919 fit). Your present ComnutU-c, with the assistance of Advisory Members as fisted above, reviewed the published Proceedings und abstracted the various subjects discussed, as a basis fur this "Digest." The Summaries that appear under each subject beading are to bo considered as "recommendations to harmonise and coordinate the principles and practices of American railroads with respect to their ujwralion." Rchjx cUuUy submitted, Commute* on Disability and Rehabilitation, Jamas K. Stack, M. D., Chairman. >ADS on, Elgin, ..'tmcnt ot jo Com* . Chicago d. Cfcioa*o, il 0fl5o*r, aiiroad. f Surcsoa a. Si. * .951. its as its ;ars and includes subject -x at the Ctd With ji-rt WHS l92l as -f*s and ->f ihe -u>>n as ppearcd Lucases nmittee nued to 949-50. is listed lubjects lereach use and pect to nor aim. Report of Commutee on Disability and Rehabilitation 19 C DIGEST ABRASIONS WITH EMBEDDED CINDERS Abrasions from cinders cause embedding of colored materials in tho skin. The result is a tatoo. All wounds should be carefully cleansed and curetted out to remove these materials. i ALCOHOLISM Every railroad oi-rasiormlly encounters the problem of an irmployo who has reported for work while undue the inllucncc of alcohol. i This condition can be best determined by evidence of mental confusion on i the part of the individual, incoordination, and/or the odor of alcohol on his breath. Further information can be obtained by laboratory examinations of the employe's urine, breath, and blood for alcohol content. ? V ALLERGY, HAY FEVER AND ASTHMA In addition to discussions on the above subject listed in the index, the Com mittee calls attention to discussions of the subject in the 1936 Proceedings by the Committee on Medical Aspects of Air Conditioning of Cars. In chronic or recurring cases of allergic manifestations, it is important to try to determine the cause of the individual's sensitization. Tho facilities of * specialist in Allergic diseases may be required in the diagnosis and treatment of such conditions. The newer antihistaminic drugs are often of considerable value in treating acute episodes of these conditions, particularly in hay fever. Epinephrin (adrenalin) subcutaneously is frequently the drug of choice in the treatment of severe acute exacerbations. AMEBIC DYSENTERY In 1934 (inii bic dysentery w;i* considered by f!i- Amimittee and discus-vd following u seal i.cn-i J pidi'imc, ippari'MiIy wig main 14 in t Im tgo. Current medical opinion is that chrome amebic dysentery is widespread throughout the United .Sratcs. The Committee recommends -tmly of an em ploye for this discu.se when prolonged or recurrent enteritis is complained of by him. AMPUTATIONS The end result of amputation at the various levels is extremely important, and furthermore, the duties of the Amputating surgeon are not finished until the amputated extremity has been fitted with a satisfactory artificial limb and the patient been successfully rehabilitated. Open amputation (Guillotine) is carried out primarily on potentially infected wounds or upon individuals who are poor surgical risks. The fact that further revision may be necessary should be kept in mind and all possible length main tained. The closed amputation is one which is performed in a clean field and in which the skin flaps are closed over the end of the stump. The muscle in the amputation serves the function of activation and padding. Tendons are ordinarily sectioned near muscle attachments and removed. Fascias in the closed amputations aid in the grouping of muscles around the i i 20 Association of American Railroads bone stump. Nerves in open and closed amputations are gently exposed by traction, severed and allowed to retract. The periosteum and bone are divided I i at the level of final bone length. \ In the mctacarpals, metatarsals and phalanges it is recommended to save all that is possible. In the carpal* and tarsuls 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. If the amputation in the leg is shorter than 4', theu the fibula should be resected. The ideal stump in the thigh is about 4' proximal to the lower end of the femur. Save all po.-v-iblr bone in the femur proximal to 4* nbovi- the lower end of the femur. The ideal stump in tin fnri-arm is 3' above the lower end of the radius. I)o not cut the r.idiu* am! ulna shorter than 1* diMul to the insert ion of the biceps. The ideal stump in the arm i- J" ab-wt tie- lower end of the humerus. The urea of elect ion in lie humerus runs di.-taf to A" la-low the upjicr end of tin humerus. Th i onloiir of the rlioijj.J. r i imp! e.i he h-a vine the humeral head. I'o.-tnporatiwlv a reasonable pMe-d of tiim s!>>ui.f !>' allowed for healing, and then physiotherapy should Ire administered promptly and thoroughly so that the contour.- beat adapted to wearing of an artificial limb are secured in a minimum of time. The best functional results are obtained on those individuals who have prompt and efficient surgery, adequate physiotherapy, proper fitting of the limb and adequate instructions and follow-up for the most efficient use of tlic limb. At the present time there art- several amputation centers which special ize in teaching the amputee to get the maximum use of his artificial member. ANTIBIOTICS With the discovery arid refinement of untibiotic methods and therapy, an increasing number of these are firing made available for use. Many of these have sjn-cifie afiimtii-s for certain organisms, it is imjKirtant wlien ono is treat ing an cstublj-hed infection that U,e enu.-ativc org.am.Mn be known if this cun lxreadily determined. It is also helpful to determine the sensitivity of the organ ism to the various antibiotic drugs. In this way therapy can be. specific and the results are therefore surer and recovery expedited. The patient may develop a sensitivity to these drug* manifested by cutaneous and other allergic phe nomena. The value of antibiotics in the prophylactic treatment of wound infection is still undetermined. Antibiotics should be employed conservatively. i Pait r to b T ,, Back Injuries: BACK CONDITIONS A practice has Ix-en made on a few railroads of making routine x-rays of the spines of ull npplirants for emjiloyinrnt, particularly those in train service for evidence of anomulies, previous injuries or disease. The value of such examinations is questionable, but may be of vuiuc in any future complaiuUs of the employe. One railroad, in addition to making the usual examinations for employment, had mode x-rays of spines of 1189 applicants who passed a satisfactory physical examination. X-rays were made in two positions, with following abnormal ities noted: Spina bifida........... ..... ................... ..... ............................................ 235 Scoliosis............. ..................._............................. ............................... 109 Lumbar ribs_______ ______ __ ___ ________________ __ ___ ____ 93 Ai trivi in m <J by xde<i all not v the Tula > the *r Do pa. rus. ling. y so ma iuve the' i d- rse :t- , So A he 'or ny it, al a- Report of Commutes on Disability and Rehabilitation 21 Proliferative obungM-......................................................................... 85 Sacralization.......................................................................................... 61 Deformity r*f ........................................... 37 Six lumbar vertebrae.......................................................................... 31 Deformity <>f transverse process..................................... 17 Incomplete union of 1st and 1M sacral segments....... ....................... 25 Eleven <J<a>.l w-rtebrac--i l'-vi.n ribs................................................ 1-1 Four lumbar tvrfebrae 9 Tim I1-ri if..i >I 11<-(na*' I lino n nl. < t ('.oKiiiital-li no inity Kiiiiiin .. .. 4 Variation of intervertebral dt>e....................................... 3 Cervical riba.................................. 6 f Congenital deformity of Ixxly ofvertebra....... .................................... 8 Incomplete union of hunhia and articular process--............. _....... 5 Fractured riba......... ............................................................................. 16 Tuberculosis lungs............................................. ............_........... ....... 12 Fractured jielvis............. ........ ........................... ..............--------------- 4 Fractured vertebra.................................................... 10 Spondylolisthesis....... ..... ....................................... _................... ....... 3 Tuberculosis vertebrae.............................................. I j- Exostosis of rib......... ..................................................................... 1 Calcified ilio-lumbar....... .......................................... 2 Tol.'iJ v ii i iIioih 7t)0 Total rui-ca shutting v.itiali-uis .................................................... 554 Total congenital mid developmental........................................... 635 Total number of ca.>ca_.._.............................................................. 1184;. Painful Backs: to be du- to 1 n\ 1 .1 li nt v d . i i.v 1 . rn/d.iM-t and ilh-g-'d There are numerous <\-iu.-v< for pniniul 1L.u'k-. -1,t(i<- .,f which are as follows: Tro-fiititis t -.iigerul d .bivcN Chronic np['nli<-itis Arthritic prnecsscs Gull stones or gull-bladder mfe.lions i-'oei of mfeetion Spastic constipation I'ri-tim: Kenal calculus Sjxmdylolisthusis Hctroperitoncal calcified glands Curvature Abdominal ptosis Tumors of the cord Mucous colitis Metastatic tumors . Carcinoma of rectum Trichinosis Pregnancy Hemorrhoids Fibroses Neurosis Ovarian cysts Flat Feet Prostata calculi Malingering Renal ptosis Etc. Any employe complaining of back pains which he alleges to be due to some trivial accident should be examined thoroughly with above possible causes kept in mind. 22 Awocwiion 0/ American Railroad* Sacro-lllae Complaints: The diagnosis of sacro-jli&c conditions is made too frequently. The great majority of back complaints given this name are in reality lumbosacral lesions with lateral reference of pain. Infections or other inflammatory conditions can involve the sacroiliac joint but the diagnosis of sacroiliac strain or sprain should be looked upon with suspicion. _______ _____ Spondylolistheses: Spondylolisthesis, or displacement of one vertebra on another, occurs more often in the Juinbosucnd junction than in any other region. It is commonly af'-oriutej with r<m f if <i* f. cl in the jk tjm-J<^ of tie- fifth lumbar vertebra, which allows the laminae and articular fnr>m to remain in normal relation to the sacrum, while the body of the fifth vertebra displaces forward. This con dition may exist for years Without symptons and may be very mild and ac companied only by local pain, or it niny be extreme and associated with symp toms due to pressure on the cauda equina. Uiagicj.-i-' may be "*!.<; I'tcd by proja-r txaininal mri of the back, but x-ray is the only way of confirming the diagnosis. BLOOD PRESSURE An employe with high blood pressure, if persistent and associated with cardio-vascular-renal disease or diabetes, etc., is an unsafe worker and, if in train service, is a menace to other employes and the public. An employe in train service should be removed if the systolic pressure is over 200 or diastolic is over 120, or if the heart apex is to the left 0/ the nipple line. Employes whos* blood pressure is noL consistent with their weight and age, especially when associated with evidences of curdio-vuscular-reunl damage, should be kept under observation. BURNS Ilurn* are to be looked upon a* wound*. In the rase of Ut and 2nd degree burns, the wound is closed ami infection will not penetrate unless the protected skin layer is broken in the course of treatment. In 3rd degree burns, the wound usually is an open one and is to be treated with the resja-ct aqcordcd uny other open wound. ' The management of the extensive 3rd degree hum is curried out along two lines, that which cmirt rns the treatment <>f the wmjml it.vlf and that whiHi is concerned With tin* hyslvmii- abnormalities that follow rUriisive burns. Fluid, blood and scrum lov> 1.- part of the burn picture, mtd an up-set of tlw protein, serum chlorides and other blood constituents should be anticipated and coun tered from the beginning. By the use of a mild cleansing agent and massive pressure dressings, infection can be held to a minimum and the closure of the f wound by a split thickness skin graft should be done as soon as possible. If the extent of the tissue destruction can be surmised early, then excision of this area and subsequent grafting will hasten the healing process. If the extent of the i bum cannot be determined, a line of demarcation may be waited for and then 1 excision of the necrotic skin carried out. When the general condition of tho patient permits, early excision is preferable to waiting for the established ! sloughing to occur. Plastic procedures for the relief of burn contractures are considered only after primary healing has taken place and the patient's | chemistry is in good balance. 1 1 t A; natic chem grout dy-8pi and c mont! En lesion auri'i fibrili. frc(j u< An be pn. - AcsMu: causes vision, is iinpa Engii should I This af whether One h fornmtn causes u however carbon > ly dcstn decay. Inst rui thatthe the mstn al train t> The N Chicago Septcmb* 1&48), an to the ger with heat he great l lesions .ac joint on with :i more nmnnly rtebra, .tion to .3 con* md ac* symp- c-ray is l with l, if >vor hue. ! ngc, mage. gree fed Hind her f.vo h ts `lid, ein, >UQ- dva the the res the >en .he ed ire t'e Report of Committee on CHifdbxliiy flrui Rehabilitation 23 CARDIO-VASCULAR-RENAL DISEASE A person with cardio-vnscular-renftl disease should hAve a careful exami nation. This examination includes the heart, blood pressure, urine, blood chemistry, and a cheek on the clinical symptoms. The eyes, including the eye grounds and vision should be noted. Dizzy spells, angina, edema, and r dyspnoea should be carefully evaluated. The conditions of the heart muscle ; and coronary vessels .should be determined. Repeated examination every six months or oiterier is important. i Employes in tram, engine, yard, and signal service with advanced aortic lesions, definite myocarditis, heart ('look, aneurysm, and angina jiectoris and 1 auricular fibrillations should be removed from service. Persons with auricular 1 fibrillations have a high mortality rate. Cerebral and other complications 1 frequently occur. An employe with coronary occlusion should be removed from service until i he presents satisfactory evidence of recovery without residual damage. ft CATARACT K % A cataract in one eye reduces or destroys the vision in that eye. r After operation on one eye the refractioo of the two eyes ts different, which causes defective vision and judgment of distance Is poor. Post-operative f vision, corrected or uncorrectcd, is exceedingly poor and judgment of distance is impaired. Engine And train Horviec men with cataract, whether opemUal on or not. should be limited to x rviees which they e;wi jierforni wifely and Hatwfactorily, rhis applies nl-.o to engine and tram service men with bilateral cataract*, whether operated on or not. i CHARCOAL HEATERS, IN REFRIGERATOR CARS One hazard involved in the u.se of charcoal heaters in refrigerator cars is the formation of carbon monoxide ga*. which if inha!"d in sufficient quantities cuumis unconsciousness, und sometimes death. With ordinary precaution, however, this ho/ord is found '> I < -liirl;t. fu addition, it is found that the carbon monoxide gas developed u, beneficial to commodities shipped, apparent ly destroying bacteria and insects m the fruits and vegetables, and retarding decay. Instructions are issued hv all com panics u.-ung charcoal heaters, and it 13 found that the employes handling these heaters soon liecume just as conversant with the instructions concerning handling these heaters as they are with convention al train and operating rules. The National Perishable Freight Committee (516 West Jackson Boulevard, Chicago 6, Illinois), has issued a circular on this subject (Circular No. 20-0, September, 1048, and Supplement No. 3 to Circular No. 20-C, December, 1048), and these rules, with some modifications, are still in uae. In addition ' to the general instructions, placards are attached to each side of cars furnished with heaters, reading as follows: WARNING POISONOUS FUMES Heated Car (etc.) wfpywff**- sswpto-* i 24 Auociation of American Ratiroada ) CHRONIC ARTHRITIS Chronic arthritis may be divided into rheumatoid arthritis and hyper trophic arthritis. In rheumatoid arthritis (chronic infectious arthritis, atrophic arthritis and arthritis deformans) the etiology is suspected as being infectious. The knees and fingers are chiefly affected, although the disease may be shifted about from shoulder to elbow, wrists and spine. Hypertrophic arthritis (degenerative arthritis, osteoarthritis) is usually a disease of people past middle age. Obesity or over-weight may aggravate the disease. In this condition there is a definite cartilaginous destruction in the joint and the cartilage is worn away and the underlying bone is exposed. These two types of arthritis cannot definitely l>e wholly divided one from the other. Gout also should be considered m the diagnosis and treatment of arthritis. Treatment: salicylates are by far the most useful drug in most cases up to the present time, hut as a rule thi- relief is temporary. In early cases it is sug gested that a focus of infection be id< ntified. ACTH has been introduced for the treatment, of rle-umatcid arthritis. In view of the fact that adrenal cortical stimulation affects so many important metabolic and physiologic processes in the body, great care should be exercised in the therapy. At the present time the immediate results of ACTH therapy can best be explained as dramatic. Only time will tell if these conditions may be permanently benefited. ACTH therapy can do good but it may also be harmful. Early acute cases of rheumatoid arthritis do better in general on a lower dose than is the case of long-standing more severe disease. Similar dramatic improvement has been observed with the administration of cortisone acetate. Disabilities from arthritis frequently are improperly attributed to injury. COLOR VISION A test for the defection of color defects xlmuM l>c one which <vui lx* carried out tut rapidly ns p'rculih- with maximum efhi a-in-v. The Holmgren worsteds or any standard modification have historically been very reliable. Several lantern tests have been deviat'd which arc also reliable. The Ishihura (color plate) test, which was modeled after tin- Stillings test, is rather accurate. There are several modifications 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 tests are oot reliable and therefore are not recommended. THE "COMMON COLD" AND UPPER RESPIRATORY TRACT INFECTIONS Reference is made to address of the Chairman of the Section on Interna) Medicine of the American Medical Association at their convention in June 1950 on "Some Problems of the Common Cold," together with his list of references (J.A.M.A. 144; 287 Sept. 23, 1050). This is a rather complete summary of present concepts as to etiology, treatment and prophylaxis of the common cold in 1950. Also, attention is called to discussion by H. A. Reimann on "Viral Infections of the Respiratory Tract" (J.A.M.A. 132; 487 Nov. 2,1946). The proph;. quart* is of b: while i types c Atte: and it engine might i Hyg.. is advi-. curly m aeriou- .Sir:.; . or th<-rafflicted muscle b Engirv can peri Cloves soted tin and inert ia the suitable c! and thorn It in a<! svusitivin involving See "IV It is agr. any haznrcapacity v di;d<eUv l:. Diabetic normal ind fundus find especially m Attention lower extrei particulars Attention vascular dej It | Report of Committee on Disability and RekobiliUdion 25 r }' The Committee agreed that vaccines and vitamins arc of little value in the prophylaxis and treatment of colds; that .stiTilizution of the air in occupied quarters by ultra-violet light irradiation, <>r by urn-vds, -mcli :ia the glycols, is of little proven benefit in controlling the -pread of the infection; iinJ that while the use of antihi>f..ummo drugs may bo of con-idor.iblo value in allergic types of rhinitis, they arc of little value m virus t\ p<* miVi-tions. Attention is called to jKi.vitble reactions from umi of untihistnminic drugs, and it is recommended that these drugs -hould not !* u-^ni during work by engine men, or in other occupations when* poor coordination or drowsiness might prove to he disadrous. Ifygionic habit.-> are advocated as i propir.' i i*- m> <-ore, and medical care is advised if the atfecli'd individual i.-> diitre.-,. d or has a f<cr. hi turn m the early stages of a "cold" is ailvocafed. to protect tii> r contacts and 10 avoid serious complications, .such as pneumonia. CROSS EYE--STRABISMUS Strabismus usually is associated with partial loss of vision in one of the eyes, or there is aa alternating vision from one eye to the other. X person so afflicted is in the same category aa the one-eyed person. There is a lack of muscle balance and depth perception. Engineers and firemen so afflicted should be limited to services which they can perform safely and satisfactorily. DERMATITIS Gloves which will absorb creosote should not Im worn in handling of cn*vsotod timbers, IxHrause they ire likely to liecome impregnated with creosote and increase the severity of exposure. In the prevention of otl dermatitis the Committee recommends the use of suitable clean clothing, the prob-ctna >>f r\pi>M.*d skin with protective creams, and thorough cleaning of -km .after w-irk. It is advised that certain workers who may be found t have n marked sensitivity to a material u ! may r' "ime Ha:: h r (o t. -r t ;.[> of work not involving occupational exposure to the aecu-e.| nail nt>. See "I'oison Ivy and I'oisoii Oak." DIABETES It is agreed that no diabetic taking insulin -bnuM be .-11 wd to rontinue in any hazardous occupation connected with tram ?>ervicc, where a sudden in capacity would jeopardize cither his own life or the lives of others. Any diabetio taking insulin is potentially a dangerous man. Diabetic individuals are more subject to degenerative eye changes than normal individuals, and 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-oxisting diabetes, and the Committee recommends particular attention to the care and protection of lower extremities of diabetica. Attention is also called to the association of diabetic disease with cardio vascular degenerative diseases, and occasionally with coronary artery disease. 26 Attocialion 0} American RaHroadt It ia emphasized that occasional injections of insulin, as once or twice a week, are dangerous, unless patient is hospitalized; also, that newer forms 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 a satisfactory diet may be permitted to continue work in certain occupa* tions, but that an employe in a hazardous occupation, particularly in connec tion with train service, should be removed from such an occupation until the diabetic condition is brought under good control without the use of insulin, and that periodic examinations are indicated to see that proper control of the dis ease is maintained. Further conclusion--Any moderately severe diabetic, whether receiving insulin treatment or not, should be restricted. DINING CAR EMPLOYE INSTRUCTIONS; FOOD HANDLERS In 1934 following n stuttered national epidi-mn- of uim-Lic dy.-entrry, Ap parently originating in Chicago in 1933, the importance of good hygiene on the part of railroad food handler- wn* re-emphasized and Ji-t of reentnmendnf mm to !>< printed on a placard urn) po.-ded under gluv- in kitchen-- of railroad dining cars and dining rooms was pn-vnled. Comment--Several of the instructions recommended in 193-1 are sound but do not conform to recent codes of practice relating to eating establishments prescribed by the U.S. Public Health Service. Chief Surgeons are referred to recently amended Interstate Quarantine Regulations (1950) and to the Sanitation Manual for Interstate Carriers of the U.S. Public Health Service (1942). The Public Health Sendee 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 of dining car.-, food handling, And eating and cooking utensils, along with other problems with relation to sanitary procedures, are now being actively progressed by the Federal and State Public Health agencies. The Joint Committee on Railway Sanitation of the A.A.K., on which are three medical members representing the Medical and Surgical Section, serves as one liaison group with representatives of the U.S. Public Health Service in the con sideration of problems of and practices recommended for railroad sanitary pro cedures. Since World War 11 the U.S. Public Health Service ami 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 Iss-n invited to and have pfUtieijKited in these schools. Oflirers of dining cur departments are advised by the health UUlhonliea l>f fctjrh meeting-. DISEASES DUE TO HEAT There are primarily three diseases due to heat. They are as follows: l. Heat cramps--primarily duo to loss of salt. Organic diseases, alco holism, poor hygiene, fatigue, malnutrition, generally poor health, all pre dispose to heat crumps. Heat cramps may be eliminated by taking suffi cient table salt and water, dejM-nding upon the humidity of the day and the amount of sweat Jos*. A ci; an e. ha va enbe poi the tin. The e ] suf. 2. and pres 3. ceivt most The sul in railroat impressed It is J&cksonia any bazar that a "(Jjust ha iinj person enj Ah pre problem 1 by convu tary loss < could be the subject It is nice though i employe should be disqualify in any tra a week, ' slower .troiled ccupa* onneeitil the >n, And he die- I'lving y, P* on the ationa dining .d hi men. .line l the '`ting , rde the *; Slid, 'mg i'ie t'-e one .uitpro- illh 'ag ave tied co re- fi nd s C Report of Committee on Disability and Rehabilitation 27 2. Heat exhaustion is primarily due to poor dietary habits. It is pre cipitated by improper clothing, the ingestion of too much or too little food, and poor hygiene. Prolonged physical exertion in a hot environment may aggravate this syndrome if proper food, sleep, hygiene and baths are not handled intelligently. 3. Heat otroke (heat retention, sunstroke), is due to the gradual ele vation of body temperature over a period of houra or days due to the hot environment, improjicr clothing and improper di*-t. This condition may be Aggravated by puor body r|f:utlu;<*"i :md hygicno. Tim most important point in the treatment of this condition is to p.u k the patient in ice until the temperature gradually descends to 103-If) l F. Intravenous fluids may than be started ami the ice therapy gradually ui.-.jicnded. ELECTRICAL ACCIDENTS The essentials of treatment of electrical accidents are: 1. Release the electrified person from the current in the quickest and t safest possible way. 2. Institute artificial respiration immediately if victim is not breathing ' anil continue artificial respiration preferably by the Schaeffer prone pressure method, until there ore unmistakable signs of death. 3. Victims *f el-rtnc:d accidents in the tiruuly of large cities may re ceive rapid emergency treatment from the inh ilaior squad maintained by most modern Police Departments. i EPILEPSY AND EPILEPTIC EQUIVALENTS i The subject of epilepsy and epileptic equivalents is one of great importance in railroad medicine, ami the dangers of such a condition cannot l>o too strongly ^ impressed upon the Chief Singe.ms { member lanes. ft is de-irod to ciiiphasizo that all epileptic -.ci/ures, .vhethcr of the Jaeksoni/ui or any miser tyfn\ -hoiild be < wi.->c lbr (HTfnatient n-moval from any lia/ar .''->is x-rr . i.imeeted ivifh r.uln.ad ojsT.atn.ns. It is not rv>enti.'il tliat tt "Ci iinl Mai" should be exhibited, as any r.x-.<- 'bowing "IVlit Mai'' is just uM imjfort.iiit Iml.h to the employe and the employer when exhibited by liny person engaged in etigine 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 coavulsions, and the entire manifestations may consist merely of a momen tary loss or lapse of consciousness. During such a brief state, serious accidents could be caused by employes engaged in engine or train service, which gives the subject a momentous importance from the Railroad's standpoint. It is recommended that all coses of disruption of the mental faculties, even though momentary, should be carefully investigated before permitting the employe to return to duty in any hazardous occupation. Any recurrence should be considered sufficient to warrant the affection as being classed of a disqualifying nature and such employes should be prohibited from engaging in any train or engine work, or other hazardous occupation. 28 Association of American Roilrnads FIRST AID AND EMERGENCY TREATMENT First Aid should bo considered as that treatment which is given to a sick or injured person by laymen. The services of a Physician should be referred to aa Emergency Treatment and not as First Aid. The essential principles of First Aid are already published in a pamphlet endorsed hv this Section. Such a pamphlet should be available to every' railroad employe, particularly those who are engaged in work of a hazardous nature. FOCI OF INFECTION Tec lli, ton.-ils, |iri>.-1 itc and mhum > i*i<- I he m< > I in, jm .11 ; i I fori of mfi < l inn. Tin: nuddle ear, gallbiaddr r, ap[M u<h\, unitary LL>M> i :.nd colon an- off'-tukt.-- to a lesser degree. Carious teeth, pyorrhea and other gum infections should not be overlooked. \Vho.<vrr jnju:;. {..m c-.i.ipi.-.a d "! u, 11 n lumbal i.r social n-gmiis without objective in.c. tie- proM.-,*'- >}k,h(<J ) con-idered o' a p""ibli` offender rather tVn 11:.,:m i. I'tlioJ,,: pi.v.'ir::! exan.inal.-ni- a!ter:ti"n to (or;.! mu-imu \s ill at*.I m the improvement of general health and increased work capacity and efficiency among railroad woik.is. FOOD POISONING As pointed out by G. M. Dack in hi= monograph1 on "Food Poisoning," the term is of necessity vugue. Among the common cause-* of g.-isfr>*.:nt.C'lmnI uj>-ct> frc|U< jilly related by the patient as Coming from their fixx! or drink, and sometimes by their doctor, as the cause of then ga-uo-iucMinnl up-, t, an- I>:h-utiu and their products, chemicals, poisonous plants and animal-, protozoa and helminths, ami a mis cellaneous group of illnesses, the causes of w liieli ure unknown, but quite likelydue to virus infection*, and commonly known ns "intestinal flu."1 Osier distinguished lx ! u i i n the endogenous and the m< >re coinin'>n exogenous sources of food jK'isons. "J'totnaiiie }iois<iiiitig." ucvordiug t*> Hack and others is a lni.-nnnu-r,1 Acute g.i-tro-enii i iti> coming on suddenly wit Inn one or several hours a flew eating tainted food, and with symptoms of varying severity, usually accom panied |,v uhdommnt cramps and diarrhea, and txv,a.-i"i:illv by votniting, salivation, and severe slunk inav fii'|ii'irtlv lie shoun ! be due (.< slaphy !* Coccus tilli:.l I,.:be' n buiM Up m tin |o,,| <jiirnig lb*- prepaialion p< 11< >d or before, m,met in.-- !i u impr.i|t l...n>ilmg or st*>r:;ge, Tins tvjx-of poismi- ing is c <n. i: i"iily v. i,i n tie c< m. . t ;,i i m a nun.!" r ol null vidua I- short!y ai; : p.,t lng oi portol the .ii,,e ipa 'tio:i..nIe f>j. Par.tcri.J inlcctioio, su-.h a* .Saliicui'.U.i. Shigella, Mu j/owneros and typhoid have a more prolonged iiicuhatiou jieitod in the body than the short period seen in staphylococcus toxin enteritis. References 1 Food Poisoning, G. M. Dack, I'niv. of Chicago Press Publ. 19-13. * Epidemic Diarrhea, Nausea and Vomiting of Unknown Cause. U. A. lieiinann, cl al. J.\M V 1L*7:1 (Jan. i>: lHln. * Ptomaine Poisoning u Myth. G. M. Dack, lodus. Med. A Surg. 18:351 (Apr.) 19-19. r<". Water fr intestinal "intestinal All tinte filters. M< visible spec Colored j ployes invfi' terprct.-ife.i II l- hope. will soon l percent of color- in lJu Such Ji.-n.v cover the t his leus<. >],. glasses arc- m Vnder no cofond leasebe worn onb It is reconv or operating j A- Attention is ject Hs re/vorl* tsnme subject n Nothing fur: recornrocnd&ti' turn, to the A> ft is rt'rcigmr- Midi CotmiiUlin ex|K'Vu -.ii'vii m : "Cuininuiiicab! lutiori.s, ji,,r m Utu-ui.tr,iv peace of mind < disease present within the limit After a blow < the skull was fra or its vessels. '! movements uect that such manipi to a -wk or rruci to as jii's of First n. Such a i.trly those ! Ilifi l lmll. i'l7> ntlcra ms .-diouki :ii regions a |H-a.-ible will aid in efficiency ir," the lali -j by r !<.-tur, .inducts, >.l :i lili.S.tc likely Oder v -u.ufces li - .liter .> <*mrmi mg, ijiliyloI {XI l'U.1 poison* viduals yphoid period H. A. 18:151 If Report of Committee on Disability and Rehabilitation 2'J a T Water from acortififd domestic source is rarely the c.m-o of .in acute gastro intestinal upset, such as is seen m staphylococcus food poisoning or in "intestinal flu." i GLASSES AND GOGGLES W All tinted or colored lenses now available for gl.'issoa or goggfi-a are colored * filters. Moist colon'll filters reduce lran-im--ioii of i-crtum portions of tho visible spectrum and impair color vision scrimi-ly. Colored jiroici'iiv line, (or uli >>r goggl.-s mu,l not lo ict{ by -m~ ploiii involved in l.'ii' ofwranou of liaiiK, ufcnc <(titi<-s require nct-urnti' in(rrprHution ot (for .igiml... It is Imped that m i<l*-;il ab-m pure gla-s for Use as a protection against glare will soon be available. It will la* a neutral gray, transmitting about thirty & jx-rcent of all visible fight and affording about equal visualization of nil the colors in che spectrum. l Such lenses must be large and mounted in aviator's type frame in order to cover the entire visual field, ff the individual requires refractive correction, his lenses should be ground to Ida prescription. Clip-on lenses over regular glasses are not permitted. Under no circumstances should the.se neutral gray how's or any tinted or colored lenses be worn at dawn, dusk, mi cloudy days, or at night. They should f)o worn only in sunlight. It is recommended lb.it gl.ose* or gnggl.-j, -.wm by mploye.s Using hand tools, or ojx.-rating power machines, etc., in -l,op, [>. m;uh- - f -h:drer-proof glass. HANSEN'S DISEASE (LEPROSY) f Transportation by C.>imn Carriers of IVrsons Ailiir-ted bv or uiuler Tn-iimerit for II mcn'., fhreu.M* p i At fen I ion is called to the action !>v lie* < 'oiiun:i ........ f Direct i*m on l his ,ub- jeet :is reported m the I'foci * dmg% for l\) 'p| is, and dr.a-uasinn of Min t wirne subject in l'i..... . dnic . f*.r J'Hs op.. /I ,'). Nothing furl her Ids del e|op,-l 11.. i, )i i i ai,p.-a! i; a (}, ; ge m t fie recommendations of tin- Oomnitteo -u Di:* etirei. Medical and Surgical .-Vc- tion, to tin; A.viOcirUioit on Ihi.i >llbji el. It i.s recognized tlt.it while leprosy isc./iwd'ivd to ( a emumnnic.rhfi* disease, such communicability is of very lo.v grade .m>l not. p<> . ibfi* fn<m contact* as eXjWrivmrvd in travel of.such c:i <. <m i.ulr** id .. The d: i-.i.-e is not li-fc'i .Kiiulig "Communicable Diseases" in the 11M7 Federal lufct-fate (Quarantine Regu lations, tior in amendments thereto of IUG<). While it appears that active, uncontrolled cases of the disease should be restricted m their activity for the peace of mind of uninformed contacts, treated cases in controlled stagey of the disease present no hazard from contact, and should Ijc permitted to travel within the limits prescribed and permitted by public health authorities. HEAD INJURIES After a blow on the bead, the important thing to determine is not whether the skull was fractured but rather the extent of the injury, if any, to the brain or its vessels. The patient with a head injury should not be 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-rays can be made without manipulat- 30 Association of American Railroads mg the head, they will supply additional information. The two intracranial lesions that are most important to watch for, are bleeding from the middle meningeal artery and the development of subdural hematoma. The more severe lesions of the brain structures proper are not amenable to surgical treat ment. The patient who has been rendered unconscious by a blow on the head should be watched carefully, particularly his blood pressure, reflexes, pulse, type of respiration and pupillary reactions, and general tone of the muscles of the arms and leg'. The so-railed "lurid interval" so long nssormted with middle meningeal hemorrhage, should not lx- dejx-mh-d U|*n entirely. A jxtsoii may be rendered unconscious by concussion of the brum and by bleeding con comitantly from a ruptured middle meningeal artery. The pressure exerted by the hemorrhage will b<* enough to keep him unconscious so that the pupillary signs, pulse and blood pressure are the best indications of this. The subdural hemorrhage and its symptoms may be delayed. The neck should not be neg lected iti people with head injurie- as frequently the violence of such injuries to the head could subject the neck to "whip-lash" mechanism. HEARING DEFECTS AND TESTS Candidates for employment in train service should not be 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 in train service is not recommended. HERNIA Hernia is incident to and not an accident in industrial occupation. True traumatic hernia is so rure as to be almost non-existent. Inguinal hernia Is a defect due to a congenital, anatomical disorder, or to developmental weak ness, or to both. Neither single nor n-jx-nU'd exertions or injuries cause inguinal hernia. The problem of aggravation of herniu will seldom in- raised if pre-employment and periodical examinations ure required. The presence of an inguinal or femora! hernia should disqualify applicants for train service or laborious work. Small asymptomatic umbilical hernia is not disqualifying. Enlarged inguinal rings in the presence of a demonstrable sac or bulging should be grounds for disqualification in the pre-employment examination. On rc-cxamination, the presence of an inguinal hernia should be noted and treatment advised if it is complete or producing symptoms. Such employes should be unrated upon if their geueral conditiou jiecmits; otherwise a properly fitted truss may be advised. The development of a hernia suggests the need 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- way Acc on JaniLi mg mg The pr prevalent and newer be under r further at' AJter ii accidents For the by the C \ssociatic "It mandisro. iiupu Cal eN 60 in\ Other r* 0) IV indicate t: (2) Ko be has bee No menDisorder Psy. Par Par, r.uiml .id. lie more re.-it- hould py of - arm* Idle i may con verted nilary dural e ueg- juries aide ve m l to .l.Wrs t Kith ged in True :i is ;i i-ukrau**; r.lined icant* nia is trable ment dd be Such ;rwise <geW ie in* treat* - M J* ru? ft Report of Committee on Disability and Rehabilitation 31 way Accidents" as issued by the Interstate Commerce Commission (effective on January 1, 1922): "Accidents to be Reported--A reportable accident is an accident aris ing from the operation of a railway that results in one or more of the follow ing circumstances: "(&) "(b)**** "(c) Injury to an employee sufficient to incapacitate him from perform ing his ordinary dutirs for More fli.-m ttire-e days in the aggregate (luring the 10 days immediately following the accident. Thu rule applies to employes on duty, and to those cbased 03 not on duty, but does not apply to employees classed as passengers or tres passers. "(d) Injury to a person other than an employee if the injury is suf ficient, in the opinion of the reporting officer, to incapacitate the injured person from following his customary vocation or mode ol life for a period of more than one day. This rule applies also to employees classed as passengers or trespassers." MALARIA The problem of malaria in railroad employes does not appear so serious or prevalent in 1950, due to the use of newer in.-eciindrs and methods of control and newer drugs for treatment. Employ*-* who have contracted maUria should lx: under treatment and ohx-rvntion until three is rea.xoim.tiic n.xnur:uieo that on further attacks of malariuJ chilis will occur. MAN-FAILURE After investigation it has been found that a very Urge 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 Railroad*, w. made: "Whenever uivcxtigntion of any tram or train -rrviei: nrcident indicates mun-fiulurc na a causative factor---inch xs disregard <>f >iguni indication, disregard of or misinterpretation of train orders or rules--and aiiggcsts an K impaired physical condition as a contributing cause of the failure, a medi cal examination directed by the Company of the employee or employees so involved is recommended." Other recommendations made: (1) Periodic examinations of those whose age or previous condition would indicate that these examinations should he made. (2) Re-examination of every employe in the train and engine service when be haa been absent from work for any length of time and cause whatsoever. MENTAL AND NERVOUS DISORDERS No mental syndrome is caused directly by railroad work. Disorders of the central nervous system are: Psychoses Paresis Paranoia 32 Aaxorialian of American Railroa<i$ Minor functional nervous states Epilepsies and epileptic equivalents Organic neurological discuses Inflammatory disease of the brain and nervous system Paralysis agitaru Choreas--all forms Cerebral arteriosclerosis Other organic n< urological conditions Traumatic psychoses und neuroses Constitutional psychopathic state C'hr<>iiir al'-olioh n, ;,in| dim' roMe t i-.n All <*lhei dix-n-> of tlie br.au and neivmi' system Jlmploynunf id a vet- ran of military ser\ in- having a discharge account of being a hi* M; 1 - i mire- i- vl (.<ijld ! [-<( p-.ned tint d a f r\\nx-ript of (he lt,< du al hi-l'-l > Is* SI '-nil d Hi V. Hi J'lnployi'- Mill, a:i\ in !.t 1 d, hr !,'( be prl li.it t d to rein dn III p." Itionv of 1, |.. Hi 11 \ , m \ I,I|.- Ihi \ (I.-.-. J~ r-......... ba/.i'-ioir !-, t In ms-lvi'i or others. This evtu after apparent recovery. The following should be dL-qna'ifying for any employe who has to do with the operation of trains: Disorientation for time or place or jaTsons, continued Intense narcissism or phobias Memory loss for recent events, prolonged and continuous Ideas of reference Fixed or related transient systematized delusions Catatonic states Paranoiac ideas Loss of insight and/or judgment, gradual Moderately severe inability to adjust to reality Emotionalism, severe, rcjx atiii Chronic ulcohnliMit or other mtoxnal ions with moulnl deterioration Industrial mid familial iniidnptnbiidy due to any of the above con ditions and ide as Defects of personality--progressive Paralyses and. or paraplegia Marked euphoria and or dehi.xou of grandeur Wanton violence and de.-lnn in eiie's- Trcii.ulotis. Man,in< ring, dy-arll-.i-ic, slobU-ry sjx.-ech Mtth loss of museulo' iit.-.iieou' m !i><- M-o- r.-.t- I;. x i ;> n> i;i:. i!.* n..-. <-i hi - ! u.i. or anxiety or p'yeho--lheiiia nr hxpoi lii)iniri;i, wi.icii ha? n<>; nv-ponded to out: vein's treatment Kpil< P'V ami ep:!< ptic equivalents Hemiplegia, paraplegia and locomotor ataxiu with mtid residuals All inflammatory diseases of brain and nervous systems with mild residuals Puralysis agitaus with beginning pill roller's tremor, mask facies with or without beginning mental changes Choreiform syndrome any type, moderately severe, with or without psychic phenomena Tic douloureux if persisting over six months aad shown not to be amenable to treatment -h M m, tir thha an th.na cot wL obt *fW rea bo! tic t" * rea loci thri Wh- Tt an tit Dj exarr :.t Of f the in id fives with (->- Report of Committee on Disability and Rehabilitation 33 * Flaccid paralyses due to peripheral nerve disease or injury, affecting at least one limb l'r> tinism, imlxnhty anil middh- <Tu>s moronism r I Migraine with no remission or short remission which have not responded I t to treatment for a year 1 >ercum's diseiLse Brain tumor Syringomyelia Subacute combined degeneration spinal cord Amyotrophic df-gmiciuti'm spinal rord Multiple sclerosis Spinal cord tumor Residuals of 'kali fracture Herniated intervertebral disc with disabling signs Once hq employe is disqualified foe service in the operation of trains due to his having developed any mental condition, said disqualification should bo made permanent. No employe who has been confined to a mental institution by court order should bo permitted to return to any type of work until he has received his writ of adjudication, (.'util this is rm:i v>-d he is a legal incomjx;teut. NARCOTIC HABITUES Narcotic habitues are ii"t Mutable for railroad 'crvice. On both pre-employ ment and periodic physical examinations the examining doctor .should he par- twnlarly careful to observe multiple an >( hypodermic injections throughout tiiu body surfaces, it is most common on the arms ami thighs. Moat of these habitues over a period of years become mentally retarded, unstable, unreliable, and most of them acquire a method of obtaining funds to buy narcotics other than their normal income. The reason for stealing to obtain money to buy nareotjes i< duo (o th" fmt that ile-ymu-f take larger and larger doses of rmr- eotus to get tin: same "bang" from ih*` drug, it iinaliy cnies to the point '.vl: i' tle-y are fakii i !. uv <! s t< g. t ' / -ie' i-'ti that previously they obt e.u- d t'.'-m t.ikm^ a m -ll-r d>-se. \. lb rmii uid <.t;,.-r narcotics cost about 5b0.u0 an "iiaec and .iddut.s 501m limes u-s: tins amount m one day, this is the reason why extra m -la-y must be ob' uii'-d *, buy drugs. There are sever.il mribods of curing tle--c individuals of tiu-ir drug habit in both privaie, ami state and federal institutions, but it n known that inuny of these individuals take tle"cur:"niily to b- to start on .smaller doses again to get tin* same "bang." If tt habitue really wants to get out of this habit and really means it be takes the cure "cold 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 few return to the habit. KEISSERIAN INFECTION (GONORRHEA) The use of sulfa drugs in prophylaxis and treatment has largely given pray to antibiotics, the most common of which seems to bo penicillin. Diagnosis should be definitely established, if possible, by microscopic examination and culture. 34 Attocialioit of American kailroatU The patient should be observed periodically, at short intervals {or the first two weeks, and several times dunng the next three months to confirm cure and to pick up possible complicating infections. OBESITY Individuals who are overweight are putting an extra amount of work on their important body functions which especially involve the heart and circulatory system with a tendency to increase blood pressure and extra work on liver and kidney*. When excessive weight is earned over a period of yeari, the above organ- t' nd to fi'i .-me exhaii>.l< ! prematurely v, bub dim implies liie individ ual-' etf.cieie-y in eariyuig on their work. TJje prohli , of ol sity i* hot managed by advi.*ing /K-nple early in life a* to what their normal weight should le and for tie in ( regulate their diet -so as to keep their weight Within the normal variation*. It i* dangerous to attempt to control wright !>y the um- of drug* utile-* under competent and medical super vision. A Time Table for Kedurmg and Keguk.tmg Weight was adopted by the Section in 193*>, 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 loo little. ONE EYE Binocular vision is essential in those j>erons who have to judge distances. When a person has only oDe eye, depth perception is destroyed and the per spective becomes erroneous, and causes a hazard. Engineers with one-eye potential should be limited to services which they can perform safely and satisfactorily. PERIPHERAL NERVES Incomplete and complete stations of peripheral nerves should be repaired only under ideal conditions. Whim the wound is clean and the patient is seen within six hour period, repair can be attempted as a hospital procedure. If the wound is lit all questionable bemuse of contamination or possible sloughing of the skin, the nerve repair fliouhl hr |m.*ij><uimI am) done a> a secondary pro cedure under ideal <-u i ijmsiaiice.'. Tbv diagnose* of peripheral nerve injury should be made pre-operativcly. Tin: po"ihiliiy should be in the mind of the examiner as soon a>: 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 medieiue consist* of physical agent* which aw considered invaluable as an aid, not only in the treatment but uLso in the diagnosis of injured em ployes. This value is directly proportional to the earliest possible time it is instituted in the therapeutic program. s e c \ ii b. it (' n* 1 b< Vi A. Sir nv u.s>. trt tre: 0 for Ora tbci T. or d the < side; A> oceu cour. entr. |n*i. reel;: It IlLte: disca lll<; iug fo have i knowL .. air-' he first arc and n tin ir nlalory ; it and : above .tnhvid* ,fe a* to ID IIS to rmpt to i super- by the iHi W*1 50. Uances. .lie prr* ..ii they paired is seen if tlic ;limg <>f ry pro* injury i of the Miusory is way, Report of CommxUet on Disability and Rehabilitation 35 Heat, massage, and exercise arc the procedures most easily obtained anil the simplest to administer. The early application of elastic bandages for crushed extremities hue been found to cut down the period of convalescence and to diminish the percentage of probable disability. These agents are uUo moat valuable in overcoming circulatory disturbances and maintaining and develop* ing function. Heat may lie given m the form of hot baths, hot dressings, or dry heat as may be indicated. The value of lint water treatment in any form lies in the fact that it is a form of im.-i.-d heat and the chemical content of the water is immaterial. One form of w<-t heal, tin* arm or leg whirijiooi, combines motion with heat and is valuable m the treatment of extremities. Massage along with motion in the early stages of injury is particularly useful. The usefulness depends on the intelligent choice of the following: 1) superficial stroking; 2) deep stroking; 3) kneading; 4) friction. Hath particular maneu ver is used for a .special purpose. Exercise consists of alternate contractions and relaxation of muscle groups. Active exercise is the only measure that is known that will increase muscle strength. Passive exercise is used when healing is not complete and a range of motion instituted so us to prevent anklyotns. Forced motion is principally used to break up joint adhesions. The term "therapeutic exercise" is given to thoee exercises used on ex tremities whose reflex nerve arc is intact. "Muscle re-education" is I hat term given to those exercise* used on ex tremities where I In* lelli-x nerve are w impaired or broken. < Vnipnti--n.il I l.-ripy n <>! prxvi o v:Iu<- by pi.-unbing vurnm.-i lyjies 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 at work on his own job. PNEUMOCONIOSIS The Committee has defined and dcscrilvd the condition of pneumoconiosis, or dust di.-e;> .e of the and mentioned -ili. >->>13 and nsbe.sto.sis, ns forms of the disease most interesting to t.ulrund surgeons. Anthraeosts (coal dust) and sidnroBis iiroii ilust) .ire ineiitioned as not causing serious complications. An entrance to service examination is recommended particularly in those occupations w here unusual quantities of silica or asbestos dust have been en countered or arc contemplated ai a routine occupational exposure, Such entrance to service examinations should unludu a complete occupational history, a Cureful physical examination, and an x-ray examination of the lung* recorded on films, for diagnosis and further record. It ia further recommended that in periodic examinations of employe*, with a history of working in noxious dust, who present symptoms suggestive of dust disease: ^ 1) X-ray examination of the lungn should be done. 2) Changu in employe's occupation should be advised or considered. POISON IVY AND POISON OAC Inquiries have been received from several line* as to the beet method of car ing for susceptible section workers aod telephone and telegraph linemen who have come in contact with poison ivy or poison oak. The only prevention known appear* to be the avoidance of contact with such growth* -,3<r,c i i >oi .w . wa~ -- 36 AttoruUiun of Arnrncou Railroad* Tlioxe who have come into coutact with tln-w; toxic substances should im mediately scrub the exjjoaed parts with an abundant amount of soap and water so as to remove the poison before it has opportunity of penetrating the skin. Note--Attention is called to the A.A.It. Manual of First Aid Instructions, 1951, which states under the heading l'oisun Oak and Poison Ivy; "When it is known that contact with poison ivy has taken place, vigorous scrubbing of the 6kin with abundant soap and hot water, within first hour or two after exposure may prevent any further trouble. The same treatment, if carried out within first twenty-four hours, often results in cure. In later cases, treatment should be given by a doctor." If practicable, clothing should bv changed carefully. Oil* (rosin*) from poison ivy or p'>i.v>n oak may be on lb' < J<it 1,:.'ur frmi. same rnnlnrt, and >in- nccc.'bary further spread may be made. POISONOUS SNAKE BITE Hearing in inmd tin m-ce--ity of .-'uring the In -t medical alien lion a, Moon as possible for edmint-fration of uni i-w-tu-m * uuu, Mpp<rt j\ t- and ai.ti-shock therapy, u is urg< fit that e'-imm fir-i at I ........ ... be started in,median ?v, Us follows: 1. Apply tourniquet a few inches above the bite (proximal to wound). This ma^t be released for 5 seeomh at intervals of in minutes. 2. If proper tyjic of anti-venom serum tr- at hand, it should be admin istered at once in careful accordance with directions on the package. 3. Crosscut incisions entirely through skin about H* deep and fi" to in length, and apply suction. Suction should Ixj continued for ot least 20 minutes out of each hour for a fx/rnni of 15 hours, uml the patient should not lx- jjenniltcd to walk, or exert himself in any way. Alcoholic beverages are harmful in snake bites. REPEATED INJURIES ("ACCIDENT PRONE") It is well-known that certain employes rejxvilcdly report to the Medical Department for treatment of injuries, many of which of course are of a minor nature; whereas other employes doing the same type of work, seldom, if ever, suffer an injury. Consideration should lx* given to the suggestion that the Chief Surgeon's Office keep a file of employes who have suffered personal in juries on duty, where treatment for such injuries has been given by the Medical Department. Where the record shows that any employe has suffered three or more injuries in one year, the attention of his employer could be Culled to the fact and his work habits investigated. SICK PASSENGERS Passengers who become ill on a train may obtain the service* of a doctor, at their own expense, by requesting the Conductor to telegraph ahead to the nearest station for aid. SPECIAL DIETS ON DINING CARS Sjx-cial diets are individualistic. They vary considerably and with the allergic types of individuals are extremely sjiecific. Diabetic and nephritic diets are quantitative and qualitative, which require the supervision of a highly trai pra.-. A by >. a tho*. T: tii irril:; and i IV, shorn tp;ai SU(,[.I Go, the <" Apl icesh<lilooci IVn mamfi All* poraril have u ment i; Man Empio Arre train si Pers' and ti In w. treatmc wounds general!, immuni. (3) at tl adequat biotics a. does the un- ::3, is ,.;n ajn xk IT, d). m- -U>t -lit .d or -a or Report of Committee on Disability and Rehabilitation 37 trained dietician. Special diets on dining cars are not workable, hence not practicable. Any special diet is the responsibility of the passenger and should he selected by him from the regular menu. SPRAY PAINTING Complaints of employes engaged in spray painting are apparently chiefly those oi irritation of the skin, respiratory passages, ami, occasionally, eyes. Then: are a num:>er of protective creams on the market, which can t>o applied to exposed skin areas before going on duty, that not only protect the km from irritation, but render any paint that gets on the skin easily removable by soap and warm water. When spraying in confined or improperly ventilated places, the employe should wear protective respirator. In some instances, in a very small confined space provided with only one opening for ventilation, a mask provided for supplying forced air from the outside is recommended. Goggles with easily cleaned lenses should furnish adequate protection for the eyes. SYPHttlS Applicants for employment in the operation of trains and in dining car .serv ice should be rejected who have clinical evidence of syphilis or a positive blood. Blood tests should be taken routinely. Periodic examinations of employes should include examination for active manifestation of syphilis. All employes with primary or secondary syphilis should be removed tem* poranly from the service and receive treatment. Latent syphilitics should have a thorough physical examination, including spinal fluid tests, and treat ment discussed. Manifestation of cerebrospinal syphilis is an indication for retirement. J-.mployis with locomotor ataxia should be pfai-cl in non-ha/ard.-u.s |si-iti`>iis. Arrested cases of nciirosyplulilics should not be returned to unrcsiricti-d train service. Persons receiving intrusive treatment should be- carefully re<-\auuned later and the results of these treatments evaluated. TETANUS In wounds of & type where tetanus contamination is likely, prophylactic treatment may be given by one or more of the following methods: (i)in wounds grossly contaminated with street dirt, tho use of tetanus antitoxin is generally considered advisable; (2) in individuals who have been previously immunised by tetanus toxoid, a booster dose of tetanus toxoid is indicated; (3) at tho present tune it appears that the antibiotics afford the individual adequate protection ngniimt tetanus in the average wound. Tho use of anti biotics ns a preventative measure carries loss danger of untoward reaction than does the uso of tetanus antitoxin. *. -vrii . ir w^ML.'iii4.- -'m&eSsuSiSiiSti&tL 38 Association of American Railroads TROPICAL DISEASES In 1W8 tbe Committee stated, "Tropical Diseases have probably been worked out to & better degree, three years after the World War in the Pacific, than they were a year ago. The vast majority of those men involved in the tropics have returned. They again have adjusted themselves to whatever treatment is necessary for them in this climate. One, of course, must be on the lookout for recurrences at any time." TUBERCULOSIS The incidence of tuberculosis is no greater in railroad employes than in others; in fact, statistics show it to be les prevalent than in employes of many other major industries. It is recognized that tuberculosis is a major health problem. Attention is called to the ijossibilitv of tuU-rculosis in clerical groups of em ployes u. in other types of employment, and it is recognized that where such employes in clerical groups as in others appear to be below standard they should be examined to determine their physical state, having in mind the 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 lx- permitted to resume work only when, after thorough examination, he iB found to be so far recovered that there are no clinical or x-ray signs of active pulmonary disease and tbe sputum is consistently free from tubercle bacilli, the case classed as arrested, and the sufferer deemed to be non-infectious to others. It is further recommended that the tul*erculous individual, after returning to service, should be reexamined at definite intervals, as 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 in abeyance one year before a railroad employe be considered for reemployment in selected occupations, assuming that no other physical disqualifying con ditions arc present. TYPHOID FEVER AND PARATYPHOID FEVER While typhoid fever has largely been controlled in the United States through the control of water and food supplies, small scattered epidemics continue to appear, particularly in the summer months. (Public Health Reports 65; 1171 Sept. 8, 1950.) Paratyphoid fever and other related enteric diseases (Salmonella infections) are still quite 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 and urine cultures arc obtained. Family contacts of such cases should not be employed as food handlers dur ing the period of contact aor before repeated negative stool and urine cultures are ot Public Var: to the necess advur: purpu> suppo: the or, system, ment, . length Oper care. sly been e Pacific, 'd in the vhatever ie on the than in of many r health a of ent ire such y should ssibility l m <i fro. :cauao .proper rk only it there itum ia .nd the '.urr.mg igainst ; bo in yment g con- irough rme to ; 1171 tiona) aeasea before 4 durIturr b. Report of Committee on Disability and Rehabilitation 39 ft-: are obtained. (See Manual--Control of Communicable Diseases. American Public Health Association, publ. 7th Ed., 1950.) VARICOSE VEINS Varicose veins are due to defective valves and arc not the result of trauma to the lower extremity. The presence of superficial dilated tortuous veins is not necessarily di.-abling providing the deep circulation is intact. Employes with advanced varicosities ill do iwdl to wear an d.xslic bandage or stocking for the purpose of protecting the thin skin over the vein against abrasions and also, to support the capillary hed of the .-.kin and thus prevent, or at least post[>one, the onset of congestive dermatitis and ulceration. Ligation of the superficial system at the groin, at the knee or at other levels, is an accepted form of treat ment, is done under local anesthesia and does not disable the patient for any length of time. WEED KILLING COMPOUNDS Operators using arsenate of lead or other toxic compounds should use due care. . MV 1>" 7iouly * Com bine oi iO-I -2&6-37 :~Ar. 9 V' f ft ;' | Proceedings of Medical and Surgical Section 43 The Ch.mrmxn: I want to thank you very much, Dr. Stack, for your report. I am sure we have all benvfuted from the general discussion and review. Next on the program is a progress report on the activities of the Joint Com mittee on Railway Sanitation, hy Or. Graham. (Or. Hubert M. Grnhnin, Director, Department of Medicine nod Sanitation, Die Pullman ('ompuny, Chicago, Illinois, rend hw prepared report us follows.) Report to Medical and Surgical Section on A.A.R. Sanitation Research and Development Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation Dr. R. M. Graham (Chairman), Director, Department of Medicine and Sanitation, The Pullman Company, Chicago, Illinois. Dr. M. 1). Clayton, Chief Surgeon, Southern Railway System, Washington, D.C. Dr. A. M. W. Ifursh, Chief Medical Examiner, Pennsylvania Railroad, Philadelphia, Pennsylvania. By Dr. It. M. Graham, Director. Department of Medic ine ami Sanitation The Ihillman Compauy Your speaker had the honor of being named Chairman of the A.A.R. Joint Committee on Railway Sanitation on the retirement lust November of the former Chairman. Mr. E. P. Mows. You will recall this committee is romjw.-ed of tbiee n-pi.-enlutives of the Medical St Surgical Section, together with three representatives each from the Engineering Division and the Mechanical Divi-ion .<f the A.A.R.; and. in addition, are three represent;!!ivt a of the t .>*. I ubite f 1 *- 1 rli Servu e, miv from the Department, of National Ife.ilth it \\ elf.ire ol Canada and the Serrelnrv. wlui is also the Secretary of <mr Medcad Si Snignal S* i tn-n. Since our report to you hist year, some progress has Ih i-ii made m the estab lishment of the Research Sc Development (Wire, under u Director, Mr. H. S. Glynn, at the A.A.R. Research l.aboratnries, in Chicago. A recent brochure, published by the A.-aoetalkm of American Railroads in March 1952 on Research Progress, describes some of the re.-wureh activities by the Association that are under way, among which are several projects for the Office of Sanitation & Development. Among them are further considera tion of toilet waste controls, garbage grinding units for dining cars, drinking water facilities and supplies, and other environmental sanitation problems of railroad servicing areas. The U.S. Public Health Service has finally completed publication in 1951 of three Handbooks on the subject of sanitation of: Railroad Passenger Car Con struction (Publication No. 95). Railroad Servicing Arow (Publication No. 06), and Dining Car* in Operation (Publication No. 93), winch were mentioned in our report lost year. .J <*-** T^ i4Jmak v -a. jlMltfnr rfUifcife T^.-^;-j- -Vi'-7,jT- >.} ' ^ta&Cka&MdAiittfa 44 Aocu2lu>n 0/ American Railroads Thcae handbook* are designed to aut>ontedi: the Sanitation Muuuul for Twin! 4 Air Conveyances Operating in Interstate Trafiio, promulgated by the U.S.P.H.S. in 1943, and the Standard Pailway Sanitary Code of 1920 and 1924 in eo far as the items in the uow handbook cover the items in the previous manual and code. Copies of these handbooks have been sent to the Operating Department Member Railroads, and it is probable that inuny of you have already seen one or more of them. Additional copies may be obtained at small cost from the Superintendent of Documents, Government Printing Office, Washington. A new issue uf the federal Interstate Quarantin. Kegulc h`Ui- wn* pub lished l>\ the I ,S. I 'll) lie lb :J l li S i V c ' in Mn 1 < h 1 9'/1 \\ hi- li Uir 11 1 '1 * Mill 1 rewording mid several amendm* uf> to the Regi;la 1 mn* as issued I.v the N-rviee in 194S. .Such amendments me reflected in tin- iiileijuetatmiis by the Servite in the Sanitation handbooks pul out b\ 11.* m last yem . (There followed a brief ofl-lhe-reenid du*uj--a u m couneein n with this Rejmft. > 'i'm. Chairman: I hank \ou, Di. Craham. We will now goon to the next order of business, which is tin- Report of the Committer on Nominations, Dr 0. H. Horrall, Chairman, I behove Dr. Hoiruli is not heie. Di. Netipaiu-r, are you on that Com mittee? Could you give us the recommendations of the Committee? (Dr. A. Ncupauer. Chief Medical Ofheor, Reading Company, then read the ballot for election of Menil>ers to the Committee of I tjterlion. Tin- ballot and the transactions covering the ap|s>iniinenl of 'JV||i-r> and elect ton of Member* are included Ut the ie:ir of thr-e I*10111 ding*., Tiik Ciiaihmav: A- we are a little ahead of schedule, I will call on Dr H. W. Slock well. Chairman of the ( omniil tee on Trauma, and Chief Surgeon. Grand Trunk Western Railway, to pics nt at tins tune tin- Report of Ins Committee. (Dr. Storkwell tin n presented he Com ti. it in V Rrpm t as billow t>.) Ti Sc- mu bn iin Su. am wo the Aii 6Ug Hie un are Wl: CL 'i U' 'iV. wli con om: frot cov Col T gre JCI l .>nd y the ]4 .-VIOC8 UU'llt < ii line ni t lie u. . j.iih -'ii < i \ n -vWl> v ;h llus. .v next ns, Dr. A lh* ... 11> 1 .11 iv. gean, ,.f btJ Report of Committee on Trauma 45 (Circular Mo. M 4 S-30S) Association of American railroads MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON TRAUMA Or. R. W. St.M-kwri! iCt.airiuan), Ctnel Surgeon. Detroit and Toledo shore Line Railroad. Dr, Ralph C. Caroihfrt. Chiel Surgeon, Cinvitii-.aii, Mew Orlemu And Tmm Railway. Dr. Duncan Eve. Chiel Surgeon. Nashville, Chatran^oca and St. Louia Railaay. Dr. C. E. Holton. Chiel Surgeon, Centra} of Georgia Railway. Dr. J. Hvbet Wagner. Chief Surgeon. Besae (oer end Lake Ena Railroad. Chicago .>, Illinois, March 31, 1952 To THE MtDIUAt, \ND Sl/KUICVL SECTION: At a meeting of tint ('.niuniMro of Direction of (he Medical mu! Surgical Section on I l*r II, I'.Ml, it ivan voted In < b.-itigo the name of the I'om- mtl.li-i' on Fra. I un-.-` In I In- I '.nilin11 f <ui Trauma. TIiH change was made to I If. .:ol< It the in-U! and incvcnrw l ho u.*:/ulu-.-i of the committee. As most of you are aware, the former Committee o Fractures of the American College of Surgeons has in recent years changed its name to the Committee on Trauma, and the Chairman and members of that committee feel that the value of its work has been mervu*cd by tins change in name. The Committee of Direction furth.-r suggested that the committee consider the coordination of our reports with those of the < .mnitUee on Trauma of the iiiii-rt*--in (-if Surgeo/iJ. The niiiiii.ii !.'< i.-[s that ibis is an rvrellent -0^4' -11*in .in I u>- hiii lal mg 1 hi *, i.in iviih our r. jxirt I his year. It lias been 11ay helpful I-, have i wo tiers of mir Medical and Surgical gmup Hint are ii-embers ot' i be ('..ii.imf f<-c >>n Tnuiua of th.; American < 'oilege of Surgeons, under tin* ('hairman-io| of I >r. Robert 11. Kennedy, at New Vork. These men arc l>r. J. Huher U igitef, Chief Surgeon of the Bessemer fc Kike Erie Railroad, who is also a mend r of our Committee on Trauma, and Dr. Janies K. Stack, Chief Surgeon 'f the Chicago and North Ucntent Railway. The committee would hko to call attention to a brochure entitled AN OUT LINE OF THE TREATMENT OF FRACTURES, fay the Committee on Trauma of the American College of Surgeons, the fourth revised edition of , which was published in 1949. This outline brings out the genera) principles in connection with the treatment of fractures, which we heartilycndorae and rec ommend to the Medical and Surgical Section. This manual cun be obtained from the American College of Surgeons at a cost of fifty renin j:r copy, which covers the preparation ami mailing only and does not give any profit to the College. The re(K>rt of the committee this year is on a subject which wo fast to be of great importance. It consists of a bulletin on THE CARE OF HAND IN JURIES, which was prepared by the American Society for the 8urgery of the -yyr. t i i ) 5 . .... > I'ffcn 46 Association of American Railroads Hand, and distributed by the Committee on Trauma 0/ the Americas College of Surgeons, through its regional committees. The proper care of band injuries wH greatly reduce permanent loss of function and do much to get the injured employee back to work quickly. This report will be discussed by Dr. Ralph G. Carothers, Chief Surgeon, Cincinnati, New Orleans and Texas Pacific Railway; Dr. Duncan Eve, Chief Surgeon, Nashville, Chattanooga and St. Louis Railway, and Dr. J. Huber Wagner, Chief Surgeon, Bessemer Lake Erie Railroad. I Protection of the Hand (Summary) Tin- first-aid car.' of wounds of the hand is directed fundamentally at protection. It i-haiild provide prntert i<m from infection, from udded injury, unri from future disability and deformity. The brM first-aid management ro'w.-l- in ihe application of a >terile protective dressing, a In in 1 on 1 pi. >>ioi 1 bandage and uiiinobili/alion by splinting in the jmjhlion of fun' lion.* N'.. att. n.j.t hbould In inadr to examine, clcutiM', or treat the wound until operating room facilities me available. II Requirements of Early Definitive Treatment (Summary) Early definitive care requires thorough evaluation of the injury with resjK-ct to its cause, time of occurrence, status a* regards infection, nature of first-aid treatment and appraisal of structural damage. For undertak ing the definitive treatment the conditions required are a well-equipped operating room, good lighting, adequate instruments, sufficient assistance, complete anesthesia and a bloodless field. Treatment itself consists of aseptic cleansing of the wound, removal of devitalized tissue and foreign material (exercising strict, conservation of alt viable tissue), complete hemostasis, and the repair of injured structures, to lx- followed by pro tective dressing to maintain the optimum )>ositinii. After-treatment con sists of protection, rest mid elevation during healing, und early restoration of function by directed active motion. III Surface Injuries (This is a separate subject which will be presented at some time in the future.) IV Lacerated Wounds Lacerations may damage skin, f&t, fascia, muscles, tendons, tendon sheaths, blood vessels, nerves and, more rarely, joint or bone. The treat ment of such injuries has four objectives: 1. Protection from infection. 2. Restoration of structures. 3. Avoidance of drformiu. 4. Early restoration of function. These objectives are furthered by pro}>eT first-aid care, as outlined in I (Protection of the Hand) and by definitive treatment. A--Definitive Treatment To be undertaken only under the proper conditions and according to the principles outlined in II (Requirements of Early Definitive Treat ment.) Careful history of the injury should be followed by examination of the hand to determine: * Position of function or position of grasp: wrist hyperextended in cock-up position, fingers in mid-flexion and separated; thumb abducted and in mid flexion, with tip pointing towurd little finger. HT '* (1) (2) (3) (4) (5) (6) (7) Full blood j of the U- (2) (3) (4) (5) The. d&mag' (1) (2) (3) In g. to awn: nevertl as are ends m Repair (1) Report of Comnuttrr on Trauma 47 (1) Location and extent of the wound. (2) Source of major bleeding. i,3) Presence of foreign material. (.4) Function of tendons, to be tested against resistance. (5) Function of intrinsic muscles. (6) Condition of nerves as regards both sensory and motor functions. (7) Integrity of hone and joint. Following ain'iheii/.utirm .,f lie- patient and application of ln'in>i.la*io blood pressure <-u(T mot to !> mlla'- d Above mni), definitive treatment of the ivoutnl consist of: (1) Thorough cleansing of wound region and then of entire hand and forearm with soap and witter or bland detergent. (2) Removal of foreign material from the wound. (3) Careful, gentle, thorough, but conservative excision of devitalized tissues, sparing all structures that may survive. (4) Repeated cleansing of wound by irrigation with warm normal saline solution. (5) Securing and ligation of divided blood vessels. These general measures are followed in appropriate vases by repair of damaged structures. Proper wounds for thus repair are: (f) Those in ivhich infeetmu has not ltee>m* c-tiddvdied. (2) Those not grossly coulaimtiatcd by highly infective material. (3) Relatively clean wounds not more than three or four hours old. In general, wounds not fulfilling these criteria are better left unrepaired to await secondary closure and later reconstructive surgery. They should, nevertheless, be as carefully cleansed of foreign matter and dead tissue as are those prepared for primary closure. In such caws severed nerve ends may Is* id'-nt ifi'-d >i n :i n'-nab'*irb.if>le -ui -ir- s or mildly um'i-d. Repair of damaged -Ituei up *: 11) .Verves a. All severed m-rves should he repaired, including the digital nerves. b. Finn arterial -ilk <>n fine needles -Imuld Is* u**d, awurately approximating the nerve* ends by .small interrupted sutures placed around the periphery. These sutures should include only the perineurium, not the nerve bundles. It is important to avoid axial rotation, particularly in nerves having both motor and sensory function. c. Nerves are to bo distinguished from tendons, especially at the wrist, by their anatomical position, softer texture, pinker color, small surface capillaries, and distinct nerve bundles neon on cut ends. Pulling on a nerve will not Ilex a finger. d. Nerves should bo handled gently, never crushed, rubbed, or allowed to become dry. .. i yaiiffil'rwr#rT^Jt^g^aiaiga^SttBii^iMB^ii8^^^&g^^fa^i^ii^8afe 48 Atsocialion of American Ilailroadt ' (2) Tendons a. All severed tendons should he repaired, including the tendons of intrinsic muscles. An important exception to this rule concerns flexor tendons severed within the flexor sheath or in the digitul flexor canal. Primary suturing of the flexor profundus in this location rarely succeeds in restoring useful function even if the flexor suhinnis is removed. Suturing !x>th flexor suhlimis and pro fundi^ in this an-ii almost inv.iri.ililv r."iili> in failure. Should even n.uior inf>-eiion uceur. failin'- i> assured. With rare except ic.us, it is hound pracl i<v in r> j>nir tin- t-km and digital iu r\e> only, leaving tin- flexor /<,r sccondury reeon- 6triutnn when severed in this region. b. Nonabsorbable Mjturr.- of silk or wire an? Used accurately to approximate the ><-vi-r<-d tendon end- after they have been cleanly squared ofT will, a hliarp knife. c. Additional incisions to secure retracted tendon ends should follow flexion creases. They should Ik- curved or transverse, never longitudinal, and never in the palmar or dorsal midline of a Anger. d. Tcudons should ! handled gently; never crushed, rubbed, or allowed to become dry. (3) Muscle a. Severed muscle.* should Is- lightly approximated with in terrupted mattress sutures, avoiding tension and constriction. b. Muscle thus repaired should lx- alive, contractile and vascu lar, all devitalized shreds Iteing trimmed away. Following these procedures, the hemostatic blood pressure cuff is released to permit identification, control and ligation of bleeding vessels. The field should be dry before closure of the wound. (4) Fascia Severed fascial and ligamentous tissue should Iwrepaired w ith interrupted mallrcs.* sutures, avoiding tension. (5) Subcutaneous tissue Subcutaneous fjiltv tis'ii>- ma\ l- lightly approximated with inlernipted fine suture*-. (6) Skin The skin should 1 closed with fine, nonabsorbable sutures. (7) Dressing Firm pressure dressing is applied, the fingers being separated, with gauze between them. The hand is immobilized by splinting in the position of function, except when suture of severed tendons requires splinting in a jxisition to insure the least strain on their suture lines. If nerves have been severed, the position of function is particularly important to prevent deformity due to contracture of uetivc muscles when their opponents are denervated and paruljzcd. i ling the tendons .j flexor tendons lal flexor rannl. !\ till* l<lOatiOO . i-n if Hu; flexor flditnis and pro- ...|itr<\ Should d. With rare in and digital nd.tiy u-vnii- I accurately to ut-.y have been a ends should or trunsverse, iJorsai midline she*' Shod, ^ted with in. I constriction, if and vaseu- "ure cuff is ding vessels. o-paijcd w it l| minted !ili bJe sutures. 4 separated, obdized by n suture of insure the i'n Severed, to prevent Alien I heir lif^xtrt of ( iunmitlir on Trnnnui 49 B--Aftercare (1) .Antibiotics and tetanus antitoxin (or toxoid) are administered systcmiealiy as prophylaxis against infection. (2) The extremity is kept elevated for the first three or four days. (3) Dressings are not removed for several days, usually one week, unless infection develops. (4) The healing of seven-d tendon* and nerves reipiircs three weeks of uninterrupted immobilization. (5) When nerves are -evered. eorreetive splinting is necessary until reinnervation of paralyzed mu-eles lias occurred. (6) Restoration of function is best .'retired, afler healing, by directed voluntary oxorei>e ami appropriate occupational therapy. Ilesjjectfully submitted. Committee on Tracma, B. \V. Stocrwell, M. D., Chairman. 60 Auociaiurn of American Railroad* (There followed on off-the-record discussion covering this Report.) The Chairman*: Gentlemen, we will now Adjourn for lunch and reconvene promptly after the luncheon for the afternoon session. (The meeting recessed at 11:55 o'clock.) At the -Annual Informal Luncheon held at the Drake Hotel, at 12:30 P.M., Mr. Kenneth B. Hawkins, Attorney, Chicago, Illinois, presented a paper on "The Trial of William Orpet," which proved of considerable interest to all and was particularly well received. At the conclusion, the Chairman extended thank.- to Mr. Haw kin- on behalf of all prrsenl. SECOND SESSION Monday Afternoon, Marc!, 31, 1!>02 The meeting reconvened at two-foity o'clock. Dr. Hansen presiding. The Chairman*: W'e gained a little tine- tlh> morning, arid we lost it at lunch, so I tbiuk wo are a!>out even. We will now go on with the afternoon session. Item Number 11 is the Report of the CommitU-e on Development* Resulting from Physical Examinations, Dr. Richard J. Bennett. Chairman. Dr. Bennett, will you present your Committee's Report, please? (For ready reference. Circular No. M & S-300, Report of Committee on Developments Resulting from Physical Examinations dated December 11, 195!, is reprinted hen-, as follows.) cue : M., 'XI t wfl .11* on 11, . '. Report of Committee on Developments Resulting from Physical Examination* 51 Circular No. MAS-300 (Superseding Cir. No. MAS-216 Dted My 31, 1939) ASSOCIATION OF AMERICAN RAILROADS MEDICAL AND SURGICAL SECTION REPORT OF COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS Committee Member* Dr. R. J. Bennett, Jr. (Cheinnen). Chief Surgeon, Elgin, Joliet A EnaMra Rnilway. Dr. J. J. Braadabnr, Chief Medical Ex aminer, Obeaapeake A Ohio Railway. Dr. B. I. Deranf, Chief Surgeon, North ers Paeitta Railway. Dr. O. n. Horrall. Chief 8urgeon, Chi<(0, Burlington A Quincy Haiiroad. Dr. K. C. Walden, Superintendent and Medical Director. Relief Department, Atlantic Coaat Line Railroed. Dr. R. S. Weatline. Chief Surgeon, Chi cago A Eaalern (Uinoit Railroad. Advisory Members Dr. R. M. Graham. Director, Department of Medicine and Sanitation, The Pull man Company. Dr. 0. 0. Ooy. Chief of Surgery, Chi cago Hospital, Illinois Central Rail road. Dr. R. Householder, Aaeiatant Ohief 8ur- {eon (Lines East). Chicago, Milwanee, St Paul A Pacific Railroad. Dr. W. W. Leake, Chief Surgeon, Illlnoie Central Syetem. Dr. 2. K. Slack, Chief Surgeon, Chicago A North Waiters Railway. Dr. A. R. Meta (ei offlrio), Chief Sur geon (Lines Eest). Chicago, Milwau kee. St. Paul A Pacific Railroad. Chicago 5, III., December 11,1951 To TH2 Medical and Surgical Section: Id accordance with action taken by the Committee of Direction, your Committee on Developments Resulting from Physical Examinations met in Chicago, Illinois, on January 6th, 1951, to draft a revision of Circular No. M,t3-J16, du-.c-d May 31, 1939, containing "Regulations and Require ments Governing I'liy-ical Examinations, Including Sight, Color Sense and Il-iring Te.ils, fur Entrance to .Si-rvmf, Promuiiuii, IVriodie and Kpicial Examinations with Method of Conduction." The "Regulations and Requirements" referred to were originally approved in 1925. I 'uder date of May 31, 1939, and os a result of experience arising from ;he application of the standards referred to, Circular No. MS-216 was issued on behalf of the A.v>ociaiion and contained the recommended ``Regulations and Requirements" as revised at that time. In light of further suggestions and study of these recommendations, they have now been further revised as covered herein, and this revision has been approved by the Medical and Surgical Section at its Annual Meeting in Chi cago, Illinois, April 2, 1951, and subsequently by the General Committee Operating-Transportation Division, A. A. R. Respectfully submitted, COMMITTM ON DtVILOP MINTS RlSULTINO FtOM Phtsical Examinations, R. J. Binnrt, Ji., MJ>, Chairman. i 5 I i It \ i I 1 1 1 GENERAL RULES 1. Applicant.- for employment in connection with the handling of engines, train.-, nr inaiiii* f<j:i:j:n< 111 a.s cnurm-mlcd below, and also applicants for 6ueli ntln-i poiimn< a- may be de-ignnled from time to time by the rail road iiuiiiaircim nl, imi>t pa-- a satisfactory physical exuminalion before cut. i lug .'civil*, including a:, i xntninaliou of sight and hearing. Applicant- for j> I*i!i<in' a. Irain .service, and all other employes who, by reason of then t-v.ujat, At. are require J to interpret color signals, must also pass a satisfm-ini \ csamina; loti on ii'inr.-.* Cl'i .1. Kny.iximn. Firemen, Molornirn, Molormen's Jlelprrs. Conductor.', Train Flagmen, Train Baggagemen, Switchmen, Brakemcn, Tram Porters and nil <in< i>. who have any duties in connection with the operation of trains. Class D. Signal Repairmen, Lamproen (Signal), Yardmastcre, Carpen ters on line work. Hostlers, Station Baggagemen, Railroad Crossing Watchmen, Bridge Walchmtn, Wreck Foremen, Track Foremen, Messeng< is whose duties involve dangi r from moving trains, Ohaiifb urs, Derrick Engineer.-., (oane Operators, Train Dispatchers, Switch Ternh rs, Interlocker I.evermen, Telegraph Operators, Student Operators and all other employes whose duties may involve the reading or display of signaU in connection with the op< ration of trains. Marine Service--CapUins Mates, Piluts, Quartermasters, Bridge Foremen, Bridgemcn, Bridge Motormcn, and Engineers, Engineers and Firemen and others whose duties may involve navigation. Class C. Car and Engine Inspectors, Ashpitmen, Air Brake and Steam IUat Inspectors, Weighmaslers, Car Repairmen, Street Crossing Watch men. Police Lieutenants. Patrolmen, Yard Clerks, Station Agents, Clerks to St;kiii Agent-. B.igiMire Agents, Ticket Examiners, r.-hers and T.-li g.Mph Repairmen 2. Examinations and rr-rxaininatioiis may be ordered at any time by proper authority. All entrance-to-scrvicc employes should have a laboratory blood test for syphilis. All employes entering railroad service should have pre-employment examinations. Proper record? of ail examinations 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 bo made a check by questioning the applicant as to age, date of birth, last occupation, etc.) i i, for nilfore antS 1 of jS ft Report of Committee on Developments Resulting from Physical Examinations 53 3. Physical examinations shall not be made immediately following sub jection :o unui'ial ia:;gue. 4. Employes engaged in engine, train or signal service including train dispatchers and sin-li oth'-rj as may be designated from time to time by the railroad manaer-inent, must pass a satisfactory physical examination or re-exuionatioii, n.-ln.lmg an examination of .-ight and hearing (and also an examination .n cuior; :i.e employes are required to read signals) at i.-t '-very tw<> t;s ur \f m<.re freqiii-nt mvrvals if required by law or oti.'-; a ,;e. 1 i b i jJod tliat cu.di employes .should l>e re-examined every y- ar from 50 to 05 and every six (6) months after 65. 5. Before an employe n p, rmanently relieved from his regular duty or his occupation changed as a result ui periodical examination made by the Examining Physician, his c.ise shall be reviewed by the Chief Medical Offi cer or his representative whose decision shall be final unless other arrange ments are made. 6. Employes mentioned in Rule 4 who have physical defects that may tend toward sudden incapacity, shall be examined at such intervals a3 may be determined by the Chief Medical Otficer. 7. AH employes mentioned in Rule 4, who upon examination for promo tion or when periodically examined, are found to have a blood pressure of over 175 and h\-s :lim -DO -y.-tolic, with a <lii.*tolic above 100 and below 1110 shall be kept tmd'T oh.*iTvit:nii. It is n ommended that employes in the above cla.-oincahon with systolic blood pre.Si.uie 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 been disabl' d by reason of accident or disease which prcdispo>*s tm-m io .-ml-kn incapacity, or whose >ight, color sense or hearing may have thereby become affected, must pass a satisfactory cxairiK. i'ion b-;'.;'e .o-umm^ lu'y. An employe .vi'ii cor :. uy <vhi-i.,n -i.ouM be removed from service until lie pr.'sonis -.ri:-fac'.:y ,itdi nve of rr-co'.vry without msidu t! damage. All employes except ilerks, who have been injured oil duty or who have been absent on account of sickness fur over thirty (30) days should be re-examined before resuming duty. The employe should be requested to furnish the railroad examiner with a .-.itisfactory medical report from his attcodiog doctor covering his disability. 9. Employes promoted to any of the 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 & satisfactory examination on colors. When the physical examination of an applicant for promotion gives evi dence of syphilis a confirmatory laboratory test shall be made. Findings should be handled as indicated. 10. Applicants for employment in positions requiring examination of sight, color sense and hearing, should first undergo this examination and in case of failure, the physical examination need not be continued. Em- i i t i i i i /A-Jia.. taitkK<aaite& 54 Attocialion of American Railroad* pJoyes undergoing periodical re-examinations should be given complete physical examination notwithstanding failure of sight, color sense or hearing- 11. When employes re-examined for promotion, periodically or by special examination, are found to have any disqualifying defects, a full report shall be made to officer to whom the examiner reports. 12. In order to prevent undue hardship to an employe in service, and recognizing the increased value of such employe because of his experience and familiarity with duties to be performed, the causes for rejection as hereinafter set forth, shall not apply in re-examination, except insofar as the disabilities found ou re-examination are such as to interfere with the proper performance of his duties, or with the safety of himself or others. 13. The standard- .v= recon,mended are minimum but if any member has 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 instructions apply lo applicants for employment and to all employes who are required to undergo sight, color sense and hear ing examinations as outlined in preceding general rules. 1. All examinations of sight, color sense and hearing shall be made by physicians. 2. Examinations must develop: (a) Sufficient acuteness of vision to see clearly the prescribed visible signals. (b) Ability to distinguish colors accurately 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 standards, and employes who are defective in hearing must not be employed in positions where their defects will prevent the efficient aDd safe performance of their duties. 5. Employes whose vision requires the ue of glasses to meet the stand ard and who.-f- duties neco-irntc th* reading r,f .-ignal indication? must, while on duty, wear >urh gin^-es. Employe* requiring glasses for distant vision must have with them while on duty two pairs of the required glasses. Where glasses are required for both distant vision and reading, two pairs of distant spectacles and one pair of reading glasses or two pairs of bifocal spectacles must be carried. Where glasses are necessary for reading only, one pair of glasses (any type) will be satisfactory, but if of the nose glass type they must be attached to the person by proper guard. The employe must be examined with each pair of glasses. Goggles worn with corrective lenses must be of the rigid type frame. An employe whose vision in one eye falls below the required standard (for example, loss of vision in one eye) shall have a special examination by the company oculist and the management shall then determine whether i and ( If h, vtsio: him he cu ]{< bung deoo: Mi oo tl satisf. denoi. eeptic menu the h right Du. stands sepan nary c the pr toriiy Em. of tli< dayhg ease c are nc Any be sat: Clo* tors, 1 Porter? tion of complete hearing. y special ii report :ce, and perience 'tioQ as sofar as with the others. aber has iat such .ring oyn. ' hear- nde by visible iploypd lor of d with live in ireveot standmust, iistant ;laases. > pairs nifoeal only, i glass iploye ndj iati<. tether * l i 5 t. 4', : * r ir Report of Committee on Developments Resulting from Physical Examinations 55 the employe can be provided with employment where his services will not produce an extra hazardous condition. ACUTENESS OF VISION Method of Testing. All visual examinations shall be made with standard test type, f'ta.io :he candidate to be examined twenty feet from the test canl.s, cover one of Ins eyes with a card, avoiding pressure on the eyeball, and direct him to read the letters on certain imos a.s shown by the examiner. If he rc-ad3 the letters on the hue marked twenty, it indicates normal vision. If he can not read the letters on the line marked twenty, direct him to read the iioes above twenty successively until a line is found which he can read. Record in fractions the acuteness of vision as determined, the numerator being 20 (the distance in feet at which the examinee is placed) and the denominator the line read. Mistakes of not more than three letters on the 20/20 line, two letters on the 20/30 line and one letter on the 20/40 line will be considered as satisfactory reading, the examiner indicating by --3, --2 or --1, after the denominator, the numbers of loiters missed. In examining for visual per ception, the examiner should tise every means to prevent applicants from memorizing the letters. This may be done by varying the order in which the lines arc read, or by asking the applicants to read certain lines from right to left instead of from left to right. READING CARD TESTS iJir- ct >ho <- ii:d.-l:itc to read certain words, .f-nti nc> -i or figures from the .'tandard Aau-ncau Railway A-ociation reading test card, with each eye separately, and record- the smallest dzes of print read corn ctly at the ordi nary distance of from 14 to IS inches. The applicant should be able to read the print in paragraph No. 3 of the standard card to pass the test satisfac torily. EuipmeiU. A simple apparatus which prevents memorizing of the letters of the cards and by its lighting arrangement more clearly simulates bright daylight, thus permitting its use under all circumstances, and which has ease of oper&tioo, 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 OF VISION--REQUISITES Clast A. Enginemen, Firemen, Motormen, Motormen's Helpers, Conduc tors, Train Flagmen, Train Baggagemen, Switchmen, Brakemen, Train Porters and all others who have any duties in connection with the opera tion of trains. 66 Atv>ciali<m oj American Railroad* Entrance to Service Promotion P-ft~7iVamiiliATi of those in the service 20/20 in each eye tested separately, without glass es, and with binocular single vision. For m.'ir vision --read print in paragraph No. 3 of A.A.R. Standard Read ing Card, without glass'-:- 20/20 in ooe eye and not lees than 20/30 in the other, with or without glasses, and with binocular single vision. I-nr mar n-.i'l print in paragiapli No. 3 of A.A.R. Standard Rridiiir f'aid, \vi;h or without classes 20/30 in one eye and not less than 20/40 in the other, with or without glases, and with binocular single vision. Fr rn-ar vision--read print in paragraph No. 3 of A.A.R. Standard Reading Card, with or without glasses. glasses. For net graph Kt-acJ i;,. gla-ssr.-. All a, meet ;; If an employe in dav A, on c.\:n..nation fur piomotioa or on re-examina tion is found to have a vision of 20/70 or kr>- in c.vh eye, without glasses, even though his vision can be brought up to the standard above set forth, Method by glasses, lie must be examined by an oculmt designated by the company, The ; for recommendations as to whether his vision will interfere with the per formance of his duties or with the safety of himself or others. 1 permit > iI screen < stripped Class B. Signal Repairmen, Lampmen (Signal), Yardmasters, Carpenters stand in on line work, Hostler*, Station Baggagemen, Railroad Crossing Watchmen, 1 Evid : Bridge Watchmen, Wreck Foremen, Truck Foremen, Messenger# whose cases of duties involve danger from moving trains. Chauffeurs, Derrick Engineers, physical Crane Operators, Truin Dispatchers, Switch Tenders, Interlockcr Levermen, Telegraph Operators, Student Operators and all other employes whose duties may involve the reading or display of signals in connection with the einnriat. other tu ment, ti. operation of trains. Marino Service--Captain?, Matos, Pilots, Quartermas ters, Bridge Foremen, bridgeraea, Bridge Motormen and Engineers, Engi of lujt-e: be noted neers and Firemen. be c&rcf; Entrance to Service Re-Examination of those in the service should h' both an; pericard. 20/20 in one eye and not less than 20/40 in the other, with or without glasM-?, and with binocular singbvision. 20 JO in on<- r\t: and not loss than 20 50 in the other, with or without gin.-: :>'! w i'li binocular ningj<vbuii,. the hear for'- and ami do!i t-xaniiiuthe prr.-< For near vision--read print in para For in-ar vision--read print in para i of the ij graph No. 3, of A.A.R. Standard graph No. 4, of A.A.R. Standard i genitalia Reading Card, with or without Reading Card, with or without | other abr. glasses. glasses. j Thebu Clast C. Car and Engine Inspectors, Ashpitmen, Air Brake and Steam j lapses,fi- Heat Inspectors, Weighmastcrs, Car Repairmen, Street Crossing Watch | Theapj men, Police Lieutenants, Patrolmen, Yard Clerks, Station Agents, Clerks cal bistor to Station Agents, Baggage Agents, Ticket Examiners, Ushers and Tele There s graph Repairmen. for new t nation a in vice . tye and j 20/40 in with or ..-sea, and s ir siogl -jmq-- read graph No. Standard d, with of 6. :-examitt* ut gloats, set b, con the r~{~ Carpenters Watchmen, ;c,r3 whose Engineers, Levermen, yes whose ,n with the .;;vrt,rina3' i;Crs, Engi* those ,t v.-s than or without ular single lot in per** Standard or without and Steam ing Watcb-nts ^'erk* , a. ! i ( | i i I Report of Committee on Development* Resulting from Phyvital Examinations 57 Entrance to Service Re-Examination of those in the Service 20/30 in one eye and not leas than 20/40 in other, with or without glasses. 20/ 10 in one eye and not jess than 20.'50 in the other, with or without For near visum--read print in para graph No. 3, uf A.A.K. Standard Heading Card, with or without gi.U^C3. F,,r i;i:ir vi'ion --read print iu para graph Xu. 5, of A.A.R. Standard Reading Card, with or without glasses. All applicants for employment, not mentioned in Clas9 A, B or C, must meet the visual requirements for a re-examination of Class C. PHYSICAL EXAMINATIONS Method of Examination. The applicant or employe is required to remove sufficient clothing to permit of a proper examination, the examination to take place behind a .-'ill'll or in private quaru-io. All iinv employes .-houhi be completely -Anpp.'d. including .-hoi-s and ut .\.tin:na::nn. The examinee is to ifanJ in a bright light and present .^ucc'-.-.-ivciy front, hack and sides. Evidences of the following should be looked for*. Abnormalities or dis eases of the eyes, ears, Dose and mouth, retarded development (mental or physical), deformity or ruvymineiry of body or limbs, spinal curvatures, emaciation, eu*ancons or oti,.-r i\'<rnd di- ugl.indm.n- 'uvllings or other tumors, jind.-i, vuric6.>itu\-, vu-.uciucs, indications of medical treat ment, such aa Mi-tor, stums. 1i::,* i`: m - i 'in t;.>m i.Inuni.itr.ituin of iiijieiion.v I'.-i.J. iii i -i ir i i .li - i., .(' .npirics and up -rations -hould bo noted. Th<: huv.ls und f.rt and viii.-us joints of the body should be carefully ex.itniii. il to <J. <:;uniu: ':,.nr fsiictioual e:!i.ji*-ncy. The chest should be examuwd ly in-peet.un, j'ulpntn.n, pr-ren.-sion und auscultation, botli anteriorly and posteriorly, for nilH'reul'.sis :md other lung, pleural, pericardial or mediastinal conditions, and vdvular and other diseases of the heart. Check blond pn-.-uro and note h-art action und n-piration be fore and after The >-cuinn.-r . In.old I'.iri fnlly inspect the abdomen and note abnormalities. While the patient is coughing strongly, he should examine the umbilical, femoral and inguinal regions in order to determine the presence or absence of actual or potential horniae. Any enlargement of the various canals should be noted. Inspection should be made of the genitalia for venereal scars, varicocele, orchitis, urethral discharge, and other abnormal conditions. The buttocks should be separated for the detection of hemorrhoids, pro lapses, fissures and fistulas. The applicant should be thoroughly interrogated relative to bis past medi cal history. There should be maximum and minimum height and weight standards for new train and engine employes. \ 1 \ 1 l 1 l \< <-**r Ifo iVTii -Jin ~ iiijttl^'ii'a^ii^iii f iitfrffirSi 58 Association 0/ American Railroad$ Minimum and maximum blood pressure standards for net? employes: It is recommended that an applicant for railroad service should not exceed a mAiimum systolic blood pressure of 150 or a minimum systolic of 100, and a minimum diastolic blood pressure of 60 or a maximum diastolic of 90- Recording of Physical State. Physical examination should be made of all applicants for employment. The examination should be accurate and thorough, recording negative as well a3 positive finding.-. The extent of the examination depends on the Htnndards di-fluid (or tin: various The report form should cove: tiie examination for entrance into lh< .service, promotion, riturn to service, and periodic examinations. Height Weight Hair Nationality Age l.ws C oio: J White Occupational History Former dust or other hazard? Physical State Appearance. Vaccination. Narcotic habitues shouid be disqualified. Special attention should be given to constitutional diseases including diabetes. Weight (Height) Compared with height and age. Report oj Committee on Developments Resulting from Physical Examinations 59 "IDEAL" WEIGHT TABLE Based on Maximum Longevity Ideal Weights for Men. Ages 25 and over. Height (\\ nh shoe*) Feet Inches 52 53 54 55 56 57 58 59 5 10 5 11 60 61 60 63 Weight in Pounds (As Ordinarily Dressed) Small Frame Medium Frame 116-125 119-128 122-132 12G-13G 129-139 133-143 136-147 140-151 111-155 1-18-159 152-164 157-109 163-173 1GS-180 124-133 127-136 130-140 134-144 137-147 141-151 145-156 149-160 153-164 157-168 161-173 166-178 171-184 176-189 Large Frame 131-142 133-144 137-149 141-153 145-157 149-162 t53-166 157-170 lflt-175 165-180 169-185 174-190 179-196 184-202 (Above Table from Metropolitan Life Insurance Co.) CAUSES FOB REJECTION OF APPLICANTS FOB EMPLOYMENT General Medical Conditions 1. Pi.i!,ofcs Mel'mis. 2. Severe malnutrition. 3. Pellagra. 4. Avuanuno.-.d and other .-evore uutrdional conditions. 5. Osteitis iibro.-3 cystica. 6. Tetany. 7. Addison's disease. 8. Froehlich's syndrome. 9. Simmond's disease. 10. Hyperthyroidism. . 11. General debility. 12. Combination of three or more chronic conditions, which individu ally are not disqualifying, but which when together cause general debility, anemia, circulatory and/or mental infirmity. 13. Acute systemic diseases, such as infectious fevers. 14. Marked overweight or underweight, taking into consideration height and age. 15. Generalised or localised lymphadenitis. 60 Ateociation of American Railroad* The Eycs--1oss of eye, total loss of sight of either eye, trachoma, entro 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 lens, pronounced entropion, pronounced dis eases of the lachrymal apparatus, symblopharon, tumors, abscess of the orbit, nystagmus, pronounced asthenopia, glaucoma, color blindness (in certain occupations), diplopia and Joss of pupilary reflexes to light, gun barrel vision, hemianopsia or loss of depth perception. --Color Vision-- A test fn: the detection of color defect- should be one which can }>e cnifi'il m/ ;i riipidiv nv j <.;) ,1, \<. i:; lu.'isinuim efficiency. The JImIiuj'k n v.oi :.d m; ju,v ; Irui'hir1 MiMibHr.,i j(,n h:ivr his1'ricJ]y b< t \ ' 11 luhh . S( lii I. ` - ), . v< 1 H d'V]-<d W huh :U c a!-o rtl.i.Mr. T;.< I-ii.!../.. (co1<t ; t<-:. which \\;i-- modeled after lh<- illir.g1 t'-t. i* rn'inr uerurpe There are several nv>difi- c:ri-j:>s <' ;hi- te-t he; ;Lr colors ;,tl apt Jo vary with tiir printing of tiii. colo: j-kr.'. v Color plate tes's are favored; lantern tests also are reliable. Field are not reliable and therefore are not recommended. The Ears--Dt.iinc.tj of one or both ear*, all catarrhal and purulent forms of acute and chronic otitis media, disease of the mastoid cells, and moder ate continued dizziness and/or vertigo. --Aural Test-- Mitl.'id th- luinliilalM at n <ii of 20 feel with otic cur towards lip- esamim-r, plugging tin* opposite ear with cotton; then have him repeat aloud words or numbers spoken in a conversational on" by the- examiner and record the distnoce 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 aide to hour ordinary conversation, with each ear separately, the full di-itanec of 20 feet. Employe* in train and engine f<r\u-e should not be permitted to work with the iim of a hearing aid. \<> t .ve engagi'd in a hazard ous oer-'ipari'.ii should ),< ],,himI!'.| >. i\. . ;t hearing aid. The Nose--Any serious pathology involving the nose. The Mouth--Loss of part or whole of either maxilla, uminited fractures, ankylosis, deformity of either jaw interfering with mastication or speech, such as deft palate or hare lip, marked pyorrhea or gingivitis, focal ab scesses, markedly diseased teeth, hypertrophy or atrophy of the tongue, chronic ulcerations, leucoplakia, fissures or perforations of the hard palate (if marked), salivary fi*-tu!a. hyrrtropliv of the tonsils sufficient to inter fere with respiration and when tonsils are the sent of septic foci, malignant growths of buccal cavity, and loss of enough of the tongue to cause aphonia and inability to communicate vocally satisfactorily. entro1 pupil, cornea, Ml d.a'<f till! :d (id :-t, gua icb C&D y. Tiie oricaily <-h are lodeled modifi.ruu>- d. : forms moder- ae ear : then itional I (lie of the cepted ratoly, ted to azard- ;tures, perch, al ab'nKue, palate iotergne )hom Report of Committee on Developments Resulting from Physical Examinations 61 The Head--Abnormally large head with deformity (hydrocephalus and rickets), d<Ti'c-.*.m\ from fracture of skull, trephine openings, caries and exfoliation <!' hone, injury of cranial nerves, ozena. Tito ,V( '!'<jt: toiler hump!*. goiter without >.ytnptoma, if small, may I.e accepted}, tui c:i-uImii.i .idr-mti.', Ir-ichcnl, iliyro-gl".iwal or cervical listulac, wry neck, .hr..me lirjngitis or ih-<--tso of the larynx producing aphonia, and jtrictuie m- dr. ; of :-phagus. Cardio-vascular System 1. Deco:u;.'/,-;jation. 2. Bacterial endocarditis--acute or chronic. 3. Syncopes--recurring. 4. Mitral stenosis--with decompensatory signs. 5. Coronary infarction. 6. Angina, all stages. 7. Myocardial fibroses with symptoms. 8. Systolic and diastolic murmurs accompanied by enlargements with signs as shown in No. 1. 9. Aortic insufficiency--with or without low diastolic pressure. 10. Ancury.-.m of non. U. Coronary in-uuic.euny with symptoms. 12. I'oi:odi'.r and ; m aid.:;-- a.'ii qm Lie. 13. Heart block. 11. Morgagni-Adam-Stokes Syndrome. 15. Aur:cu!.tr fibriI'.it ion. 16. Fur<<wy.-:::ji !.ic:,yrj;d:.i. 17. Art---rio.-e;L-ro.;ii. IS. Impairment of circulauou of extremities. If). In' : :u o lit '(: I: ..>n. '20. Jv\ i' h.lI . nn .t' cv ..-m,;. -. 21. Thi /*.<; or<li;> iaus and K.tynau 1'.-, Disease. 22. Car./"I- :.ij* -i-cop,;. I ppef u>:-i L<>:tr Li'r, iwtu .*--AiTcCtions common in both the upper and lower extrr*mi!i(>, chronic rheuma'i.^m, chri>nic diseases of the joints or movable cartilage, acquired **r congenital deformities, such as old or irre ducible dislocations or false joints, malignancy or suspected malignancy, severe sprain, marked relaxation of the ligaments or capsules of joints, dislocations, li.-iula connected with joints or any part of bones, effusions into the joints, badly united or ununited fractures, rickets, caries, necrosis, pronounced nxosto.M.'s, atrophy or paralysis of & limb, extensive deep or i adherent cicatrices, contraction or permanent retraction of a limb or por tion thereof, loss of a limb or portion thereof, loss of thumb or loo* of i two lingers on one band, vitricow veins (if pronounced), club foot, chrooic ulcere and disabling acquired Hat feet. The Chest--("dries or necrosis of riba, unresolved pneumonia, or pneu monitis, marked emphysema, chronic pleurisy, pleural effusions, chronic bronchitis, bronchiectasis, tuberculosis, asthma, repeated pulmonary hem orrhage or marked loss of respiratory capacity, organic diseases of the 62 Ateociation of American Railroads heart or Urge arteries, protracted functional derangement of the heart, and abnormal variations of the blood pressure. The Abdomen--All chronic inflammations of the gastro-intestinal 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 ail situation;- (exceptions: clerks and others not engaged in laborious work, who have a siugle reducible hernia supported by a wellfitting truss). The Ct MiH-l'iiiid'ii Organs (h-iioirhra, >yphil:'! and venereal sores, stric- tuii' of Hk u.-(; lira. uij'J' ' (<1* - I t< >! i' l. . i>. > ;<( win n within the abdomen, chronic <-. of tin t.-iidc ur cptdkUmu i-. hvdiocHo of the tunic and cold, unh 11> hvdiin |i j> mii:iII , J iM.t.-prugtir.v ivo, varicocele with symptoms, ifi-litiv* Ju..l:i:m: 1j-r* - m i1.-i.ims of the gi-uitulia or bladder, all organic di.-> of (!,* kidn>y. and lo> of one kidney. Applicazit.'. w;:i, laneoc, !< rn;.y i>*- uenpod wlien it is not accompanied by atiophy of to. tc-tf- p.iiti 01 an iveicut neurotic tUtt. The Sp::.t--Curii s. sf.'aa hifula. 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 asymiomatic arthritis of the spine, and pro truded intervertebral disc operated or unoperated. The Skin--Chronic, malignant, contagious or parasitic diseases of the skin. Deep and adherent cicatrices; chronic ulcers and vermin. Mental and Moral Ivfttmtu .t--Any mental infirmity, epilepsy and epileptic equivalent, diseases of the ccrcbro-spinal system, chorea, and all forms of paralysis, tabes dorsalis or persistent neuralgias,, and chronic alcoholism and habitual Use of narcotics. The RrfltjcK--AlmoTtunl icfhsis taken in conjunction with history of physical findings indicating possibility of serious disease. I-aboTafoTp blood--It is recommended that a routine blood test lor syphilis be taken on all applicants for railroad employment. Laboratory Vrinc--It is recommended that a routine urinalysis be be done on all applicants for detection of albumin and sugar. FOR PROMOTION AND RE EXAMINATION OF THOSE IN SERVICE The results of a physical examination may bring out certain disqualify ing findings, but keep in mind first, the duties that the employe must perform and secondly, the ability of the employe to perform that duty promptly and satisfactorily so (hat loss of life and property will not result. EXAMINATION OF RESTAURANT AND RESTAURANT OAR APPLICANTS AND EMPLOYES Applicants concerned with the preparation and handling of foodstuffs or dining equipment 6hall be examined before entering service. u't, and 1 iract, I hcmiual or gc-d in i weli- *. striciomen. i:c and !e with >!adder, ipanied neat' incL eraU. . pro of the .-ileptie rms of holism y -f i test sis be VICE laJifymust duty result. LB istu. if Report of Committee on Developments Resulting from Physical Examinations 63 Employes concerned with the preparation and handling of foodstuffs or dining equipment shall be re-examined, the periods not to exceed six months, which should include examination of the lungs, skin, mouth and genitalia. i Employes found to have a rotiuimnicalile disease when examined shall immediately bo relieved from duly and not juTiuiUcd to resume duly until all danger of communicability has disappeared. Food handlers with sores, skin eruptions or disfiguring rouduions on exposed parts should be relieved from duty until condition is corrected. Employes off duty account of illness oix days or longer should be re examined before resuming duty. GENERAL Many factors enter into the ultimate decision as to the candidate's fit ness for service. Where all other physical factors are normal, it is not justifiable to reject an applicant unless there are marked variations from the normal. When an applicant for employment has oone of the disqualifying defects above mentioned, but whose general condition (mental or physical) is sub standard from any cause and whose efficiency is thereby impaired, he should be rejected. In all doubtful cases the Company should be given the bene fit by the Exainioer, or if he d<.ires the matter may be referred to the office of the Chief Medical Officer. Applicants should be vaccinated at the time of examination a well-pitted scar is present, especially if smallpox is epidemic or sporadic. : Dr. R. J. Uf.ns'ktt `Chief Surgeon, Elgin, Joliet Eastern Railway 1: I ? particularly want to thank all tin: meinl*er* of this Section for the help which llicy gave u.i m i L., -.vu k. W*" - -fit weiiid to :he railroad.*, from - -i.-t l. and got their physical examination bunks and records and suggestions. We had several rm-etiieg*. not only nf the G-ninaf'e--with Drs. Brandabur, Westline, Der.mf, 11*it.ill. Walden, and my-vlf-- but alsn wth advisory mem bers from the Chicago group Imre, and those advisory members really put in lots of time. They included Dr. Graham. Dr. Householder, Dr. Leake. Dr. Stuck and Dr. Metz. I certainly want to thank all the jieople who had any thing to do with this big revision of this booklet. We took everything that was in the original booklet, which runs hack to 1939, and considered all the changes, additions and suggestions which hail been mode since that time, and ineorporated everything into one overall draft. Then by the process of elimination and going over each of these points separate!}, we finally got it down to the point where it was passed out for final approval by the Committee members. Just to make a short resume of t.hc isioklet, this is divided into three cIoxwa as far s revision requirements are eoncemcd. There have been a couple of subdivisions added to Class A, and then, of course, Class B is a different group. And Class C. As to examinations, the entrance examinations were kept about on the same level, but there has been some change given to the requirements for reexamina tion. The method has been changed. 64 Association of American Railroads We have suggested a different ideal weight table. We did the name thing with blood pressure. If we didn't have that weight table in there, and you had a man standing five-foot-tw o who weighed 300 pounds (just to carr that to an extreme), we h it he was a rather undue risk, because wc have records of people who have fallen a distance of onl> one foot and who have received a smashed oe calcis or some severe injury . So we tried to make these weights median, and we haven't gone too far one way or the other. Of course, a? you realize, the things we suggest in this pamphlet are for prremplojmcnt physical examinations, basically, and then, secondarily, we take up those for re-examination. \V< talked about hernia- this morning. On pag<- 7 of our Report we brought that m -rath* < -hu.M nri-1 t the point and J fi jf up t<i you individually * to just whom yon want<-t 1 1> admit to u hut job. \mv, if you will op< it tie discus'inn j 'in sill*' you liuvc all had a chime 1o read this, sinei it wa.- put mil u. In n.b< r of It'.'il. and you nil have cupi<- -1 wonhi be glad t<- bear w h. ' sugge-linn*. yt.u have tn make, or nit\ n-coiniin nda- tioio you m.i\ lia\f. (There followed a ge<t<-:ai, off-lhi -!*<J iJi.-fUf-'-n,ij of the various It' la.- in the Report of t}ii Committee.) Tut: Chairman: The next suhject for di^-ussimi on the program is "First Aid Equipment and First Aid Instructions." Does anyone have any ideas on first aid equipment or instructions that arc different than what wc have in the circulars? Da. R. M. C mil am (I >iri - lor, Department of Medicine and Sanitation, The 1`ulfman Company.': With regard to the m-M im tied of ai t liieial M'spu at ion that has i <-n adopted generally over the country, I thought it might be U tter to bring it up before the general session rather than wait for the Committee of Direction to meet, and 1 would like to make a resolution. Your Section's committee was cognizant of the active studies and exjrerimeut in the field of manual resuscitation when revision of the A.A.R. First Aid Instruction Booklet was completed in January, lliol, and the Schaefer method of artificial respiration was continued in the instructions at that time. Since then, further studies and reports Lave demonstrated that the modified Hoigcr Nielsen or arm-lifv-baek-pressure method of manual resuscitation is more effective, and the snn-lift-back-prcssure method has been adopted in preference to others fur instruction and use by such national organizations ns the Red Cross, the Army, Navy nod Air F<>ui\ the l'ubhe Health Service, the Huroau of Mims, and otic is. The method i- endorsed by tin- Council on Physical Mcdirim* ami Rehabilitation of the American Mcdn al As.-uciation. It is therefore proposed that the modified Helper Nielsen arm-lift-back pressure method of artificial respiration be substituted for the Schaefer prone pressure method in the A.A.R. First Aid Instruction Booklet, and I so move. Ths Chairman: You all know what the new method is. It is now a ques- tion of whether you want to substitute the new method for the one that is given in our First Aid Manual, known as the Schaefer method. (The motion before the assembly was then duly seconded and curried unanimously.) ! I I COI hav are the the 1 mi mg miha thr l l)i th: im \Vroi ( vn: Of do; abl. of i as ' I ing am: An. att< \ do, r to ( wi; i i pa') tO : kin I of t - - tli.fr thing uul vuu hud " tli.uronn nf people d a .-mashed median, and iff ;.ir prei!v, iiv lake . ive brought Uvidually os a chance to ve copies--l eommenda- ,U8 it'--`s in t is' fc us lli.'tt .in; ration, The -n a.ted up I .'lore I.. cl. I 1 -. i ; 1 \,d f sh. -I : modified Hat.-Ml i.-t li pi. d ,:i Ull2allon3 h Service, 'ouncil on nation, lift-bnekfer prone so move. w a ipust U) given i Cl' t; I* Proceedings 0/ Medical and Surgical Section 65 TheGhurmvv: The List Committee on First Aid Equipment was a special committee. and it was Mibs-'ijU'-ntly inactivated. I believe that we should have a permanent >v>m:nitto l.audli: first aid ami first aid equipment. There are a number of States iliat are now im|uinng :u to what kind of legislation they should have for first aid package an<i first aid instructions and l think the subject js one 'hat is again up for much consideration. I I think ;\v -hould have .1 ('omnutter >n First Aid included in our ' om- inittoes, l.. keep fr.-a' --ifi>; and in keep np t. date on ail tie- new thing* ` '-n.iog along. I mi.old fil.e to fia\ c a on.-erisin' oil whet hi r we -l.'i.uld have a C..in- mittee on First Aid. the vitnc as we have < 'ohmnHees on Trauma and Hehabilit.it ion ami I'hy-nad Si amiai ds. lb>u nmny are in favor of having a com mittee, more or less |x>rnuiricnt. for first nid and first aid equipment? Contrary? ',Xonc| We will therefore recommend to the next Committee of Direction that such a committee be appointed and continued in service. The next item is "Cnfiriished Business." Is there any unfinished business that any of you have in mind or know anything about, nr is there any new business that any of you wish to bring up at this time? If not, I will ask Dr. Washburn and Dr. Ciraham to escort the new Chairman to the front of the room. Cuaihmav-Kukt I >. A. M.W. Hi k*i ,(`liicf Medical Kxanuner. fVnns\ Ivaiiia Hailrmel Xystiiu''. Dr. Unison and follow nieinl>ors of tin* Section; < )f conr-e, l greatlv lc>i,iuci| it being prr. 1 lege. I I,. . n.- i- \ ,,ui < hairrnaii during the coming year. At th- same time, following, as I do. a long line of able and distinguished Chairmen, I feel very humble, but with tin- cooperation of the group as a whole, and of the varum* committees, with uch cooperation on we hove had in die pa-t. f think we -Un'tld have a mc.v .-dul y.-ar. Df. B. nnc't brought up tin mat:.-r of a im-ct mg place for m \t . u ir.eei. ing. Tin; Committee of Direction rather feels that Chicago is the best place, Old t-hat Loll Id .......... . ^ v.-e nv d'uig - i - r, ' i m v. i:li ; > \ Kief |,-iu \ * .* 1 Ul'ill -I If ilf \ . j V .'ill g' 1.-. Me ' I. ,llL li |V.' 1 I.. : ! r attendance 1 h it iiay. Wi; thought '*011 j* ot I lie >1 her Me lulu t > l.i ikdit h.v.e otie r i.. md if ij . . do. we would like to bear tie-111; they mil be given m-ideia 1 cm. Dr. C. V. Ilot.T"v : Chief Surgeon. Central of fjeorgu Ifiu'n ayl: I'd like to invite you to Savannah, Georgia, again. [ Applause). Chairmax-Klect Dr. Hprsh: Thank you very much. Dr. Holton. We will keep that in mind. Is there any other business you can think of. Dr. Hansen? The Chairman: I don't know of any other business, but before f sit down again, I want to thank everybody for all their help and courtesies during the past year. There wo* ono meeting of the Committee of Direction that l was not able to attend, and the Vive Chairman wasn't them, cither, so Df. Graham very kindly took charge of that meeting. I know that if you have the help of our very efficient Secretary, ami the rest of the men, aa I have bad, you won't have any trouble whatever this year. Thanks to all of you. 4. 66 Atsocialist! of American Railroads Dr. Wagner: I was just going to ay that I think we'd tx? remiss if we did not adjourn the meeting by a standing vote of thanks to Dr. Hansen for nia services in the past year. (The mcmtxrt* aroae and applauded.) The Chairman: Thank you very much, gentlemen. Chairsaan-Klect Dk. firR.~n: The meeting i.< adjourned. (The mating a Jjoiimcd sine die at 3:53 o'clock, Monday, March 31, 1952.) Du. T. I,. IIas-ma, Cb.'iiriitan. H. ,S. Dewhi-rst, Seep'ta ry w* ' mu the ml. w. A i mad if we did m.-cn for his I, 31, IU32.) II rll.VT, '.'i-r--tary. T-"t Proceedings of Malicnl ind Surgical Section 67 REPORT OF COMMITTEE ON NOMINATIONS AT 1962 ANNUAL MEETING AND ELECTION OF MEMBERS TO THE COMMITTEE OF DIRECTION Dh. A. nit (Chief Mi iin'nJ Officer, Rending < 'omjmny): Mr. ('h;ur- mnn and gentlemen, ynur Committee in Nominations met February J'Jth ut the Congress Hold in ( liand in line with the Rules of Order and taking inly ron-nleraiion ilic allocation of n.iiiiuco for the Committee of Direction, We have 'elected the following members for ballot : Association of American Railroads MEDICAL AND SURGICAL SECTION ANNUAL MEETING--MARCH 31, 1962 BALLOT FOR MEMBERS OF COMMITTEE OF DIRECTION (Indicate by an. ` X' the names voted for) Southern Territory (3 Year Term--Vote for One) j 1 )r. M. If. (`layton, Chief Surgetin Southern Railway S\ *tnu Dr. J. D. Collms, Chief Surgeon Seaboard Air Line Railroad j Dr. C. F. Holton, Chief Surgeon ! Central of ricnrgta Railway Canadian Territory (3 Year Term Vote for One) , Dr. K, F. Dmv.l, Chief MedieuiOUirer | I '.lll.lrll.lll V.lll'ricd It*.Ilia l'.> | Dr. 1*. I'cmvick. Chief oi Medical Services | ('anadian Pacific Raihvn) j Dr. K. K. Xi' huiwni, Chief Medical Officer | Toronto, Hamilton ami Buffalo Railway Eastern Territory (3 Year Term--Vote for One) t. Dr. H. M. Hngludt, Medical <k Surgical Director Bnltimoro and Ohio Railroad Dr. J. K. Knowles, Chief Surgeon Boston and Maine Railroad Dr. J. HuWr Wagner, Chief Surgeon & Bessemer uud laike Erie Railroad i i 68 Association of American Railroads Western Territory (3 Yer Term--Vote for One) Dr. T. L. Hansen, Chief Surgeon Chicago. Hock Island and Pacific Railroad Dr. E. A. Hinds, Chief Surgeon Denver and Rio Grande Western Railroad I>r. R. S. Kieffor, Chief Surgeon Missouri-Kansaa-Texas Railroad Western Territory (2 Year Term Vote for One) j Df. Ji. J. J > l .r'lf, ( 'In' ! Sill v't'N ` .N<.'111. r(, I'iii-ific Iijv.:i\ ! 1 >r. M. C!,i. f Hurj;. -i: 1 !*!. I.'illl-S:,l. 1 r::li''l" <> Dl . J. K. .Murk, C'Jili I ,''irgfi>li MV' mid \'<t Ih W< ' I : J llwaV Tut Chairman : Thank you. Dr. Xcupuuvt. You will note that the lust group on the sheet. for the Western Territory, is proposed for a twn-ycar term. Dr. MeU retired as Chief Surgeon of the Mil waukee the first of February; he served one year, and this is to fill his unexpired term. Th<` ballot- w ill now |>e pa-s.d out, and aftei l Ik- meeting I would ht<- t<i uak Dr. Davis, Dr. Bennett und Dr. Houk to wrve a u-ll'-is. Tiny will please come to this table after the meeting is over to help count tin- vote*. The Secretary has a tn< as ge for you now. The SECHtiAHv: Gentlemen, in order that your ballots may be projierh counted, they should lx- completed all the way down the line. Only one ballot h> allowed for a road. If tin- voting representative of the road is present, he should complete the ballot. If he is not present, someope representing him is entirely welcome to make out the ballot, but we euii only have one ballot from a railroad. The envelope calls for the name of the representative and the rail road. so pii-:;-< eln.w tho>c on there when you put the ballet back in the * n\( li>pe mi ui will know who-e railroad it is when we list the votes later on. l i he Hallot.- wen then distributed oinl rolii-i-;.--!.1 Tin' Cn.uiai w : ) w .add hke t(. ask tie t- !' !.---Dr. 1 )?(vis. 1 >r. Hi mu tt ami 1 Jr. Houk- to nu-vt with Mr. JVwhurst just outside the dom to count the ballot.-. {At Uie o|M-nine of the Second Session. the Chairman railed tijiofi Dr. I >uvi to present the n-jtort of the Tellers covering tl*<- election.1 Dk. William T. Dams {Chief Medical Officer, Delaware, Lackawanna <L Western Railroad;: Mr. Chairman, the tellers wish to p-jx-rt that the ballot ing this morning resulted in the following gentlemen being elected to the Committee of Diicctiuu: For the Southern Territory, Dr. M. B. Clayton, Chief Surgeon, Southern Railway System. f j i > Mnry, (j ' '> Mil- ..t i.?* , > oak -li'iine l-'lllot 1 ' l'" nl. he ' j >'im ie ' f. from r.nl n the ;i.i : a*h.v> * . 4 '"Mina it V-n U., " ballot- * 4 "I h> the ^Aitheni Proccedingt of Statical ntrl Surgical Section U9 For the Canadian Territory, Dr. K. F. Dowd. Chief Medieal Officer, 1 `unadian Nutional Hallways. For the Eastern Territory, Dr. J. Huber Warner, Chief Surgeon, Bessemer and Lake Erie Railroad. For the Western Territory, three-year term, Dr. T. L. Hausen, Chief burgeon, Chicago. Rock Island A Raetfic Railroad. For the Western Territory, two-year term. Dr. J. K. Stuck, Chief Surgeon, < 'hicago and North Western Railway. Tub Chairman: The next order of business will be an intermission of ;4? ulxuit ten minute* fur u meeting of the ('ununittce of Direction to elect a < 'hnirman and Vim Chuirmun. This im-eting will 1m; held either in the hall or in the room right next to the door. (A brief recess was taken.| Tub Chairman: The Committee of I )ireri ion has just completed its session for electing a Chairman and Vice Chairman. I have the pleasure to advise that Dr. liursh is cleeted Chairman for the ensuing year. (Applause] And Dr. Wagner is Vice Chairman. (Applause] 1* % t' k' 70 Attocuilion oj American Huilruadt OFFICERS AND PERSONNEL OF COMMITTEES OF THE MEDICAL AND SURGICAL SECTION FOR THE YEAR 1962-1963 Dr. A. M. W. Hurob, Chairman Dr. J. Huber Wagner, Vice-Chairman H. S. Dewburst, Secretary Committee of Direction Dr. A. M. W. Huoli, Chairman Dr. J. Huber Wagner. Vice-Chairman I Tt'l III e\piH- ||, J)(. R. J. Bcmctl, Ji.. ( hirl Sui'ge"i:. Ifein. .! !j' i iV ha-nm [<:,iiav, 20S South La Sail* Street, CI.k-;.K". Hhici- Dl. 1. (Jeldow-V. \ . .Ml ilea I D;|.('`l,|r;,l ih.ii: .;il Coiiipan;. of New .11 i-i-y. .hi.-' \ (ii\, Nev. .hr-". Ur. A. M. \S. Hu:>1,, ('i,e I M< h. .i! I.vumiii i, I'i m. . i. ani.. Il.uli.! S\ - i m, );> North U'Jnd Siic-t. I*il;< 1* l|,)ii-o A, )Vnn>vh unia. Dr. W. K. Mi.-iili r, Cluel Nuig--on, Lri. Huilo-ad, (Ki* Iti-publc Pudding, Cleveland 1. Ohio. (Term expires in lyMi Dr. Duncan Eve, Chief Surgeon. Nashvilh-, Chattanooga A St. I^iuis Railway. Nashville, Tenn. Dr. R. M. Graham, l >irvc tor, Ih jiarim* nt i>{ M* divine and Sanitation, The I'nlllt.fin Coin|tr , Chicago, lliinon Di. J. K. Slaih. < I.h I Stirgei.n, ffneugo A North WenUrn lOiilwav, 127 North Clinton Street, Chicago ft. Ulmon*. Dr. W. W. Waahlnirn. ('hud Surgeon, Southern I'ueihe Company, San ^ll^n ciaro 17, California. (Term expire.* in I'l.Vu Dr. M. IJ. Clavion. f.'hn f Surgeon, Southern Kaileuy Syaicm, VVuhhiogton, D. C. Dr. K. E. Dowd, Cliiof Medical Officer, Canadian National Railways, Mon treal, Quebec, Cariuda. Dr. T. L. Hansen. Chief Surgeon, Chicago, Rock Island and I'uctfic Railroad, Chicago, Iilitun.*. Dr. J. HuIht Wagner, Chief Surgeon, Ro.-einci and 1-ike Kne Hailroud, f>2?> William I'enn Place, Pittr-burgh. I'cniisylvania. Committee on Disability and Rehabilitation Dr. Janies K. Stack (Chairman;. Chief Surgeon, Chicago A North Western Railway, 127 North Clinton Street, Chicago 6, Illinois. Dr. J. F. DePrco, Chief Surgeon (Lines West!, Chicago, Milwaukee, St. Paul & Pacific Railroad. 407 Medical Arts Building. Seattle 1, Washington. Dr. S. M. Eoglisli, MeJical and Surgical Director, Baltimore and Ohio Rail road, BAO Central Building. Room 217, Baltimore 1, Maryland. Dr. R. S. Kieffei. Chief Surgeon. Mi.-souri-Kansas-Texas Railroad, St. Louie, Missouri. Dr. W. W. Washburn, Chief Surgeon, Southern Pacific Company, Hospital Department, 1400 Fell Street, San Krannsco 17, California. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr Dr. Dr Dr Dr Dr Dr THE 1962-1963 orn Railway, unv ot \>-w road System, lie Hmldmg, 'ns- y. 11{;il ion, Tlu '.In.a-, 127 ., Sail Krati- A duiigion, I a ,iys, Mon.tic Railroad, hulfoad, .125 rth Western see, St. Paul aahington. d Ohio Rail'laod. d, St. Louis, ay, Hospital Proceedings of Medical and Surgical S>tiion 71 Committee on Trauma Dr. B. W. Stockwell (ChairmaM. Chief Surgeon, Grand Trunk Western Railway, Detroit. Michigan. Dr. R. 0. Cnrothers. Chief Surgeon. Cincinnati, New Orleans and Texas Pacific Railway. ('iin nmali 2. Ohio. Dr. Duncan hue, ('find Surgeon, Xuslivillr. ('hni.tunoogn nod St. Dunn Rail way, '2(MJl Hayes Street. Nashville 4, l ennc.ssre. Dr. C. F. Holton. Chief Surgeon. Central of Georgia Railway. Savannah, Georgia. Dr. J Pfulx-r Wagner, ('hief Snrg"i>n, Bc.omT and I ,iko I .Vie Railroad, 525 Wilf.um Perm I'l.nre. I'iMdutrgh. Pennsylvania. Committee on Developments Resulting from Physical Examinations Dr. R. J. Bennett, Jr. 'Ominnan), Chief Surgeon, Elgin, Joliet A Eastern Railway, 203 South 1-aSalIc Street, Chicago. Illinois. Dr. J. J. Brandabur, Chief Medical Examiner, Chesapeake A Ohio Railway, Huntington, West Virginia. Dr. B. I. Derauf, Chief Surgeon, Northern Pacific Railway, St. Paul l, Minne sota. Dr. 0. H. Horrnll, Chief Surgeon. Chicago, Burlington A Quincy Railroad, 347 Went Jackson Boulevard. Chicago G, Illinois. Dr. K. C. Walden, Su|X`rmti-nd*-nt and Medical Director, Relief Department, \ilantie Coast Cine Railroad. Wilmington, North Carolina. Dr. K. S. Wcsflirn-. <'he-f Surgeon, Chicago A Eastern Illinois Railroad. 334 Went o.'lrd Slro-t, Chicago, Illinois. Committee on Medical Aspects of Air Conditioning of Cars Dr. R. M. Graham {Chairman'. Director, Department of Medicine and Sanitation, The ihillman Compunj, Merchandise Mart Plaza, 222 West North Bank Drive, Chicago .*14, Illinois. Dr. M. B. Clayton, Chief Surgeon. .Southern Railway System, loth arid K Streets X. IV., W idnugtosi. !).C. Dr. C!;.-ir|,.j B. F.-nwi-'V. Chief M'dic-d Service*, Canadian Pacific Railway. W ind-or Si i 11, ,|), M'.n l re , |_ ( 'mu In. Committee on First Aid Dr. E. C. Olson Chairman', f `l.ief Surgeon. Illinois Central Railroad. 5,300 Stony Island Avenue, Chicago, Illinois. Dr. V. W. Hollo, Chief Surgeon. St. LnuU-San Francisco Railway, St. Louis. Missouri. Dr. A. XnipaiKT, Chief Medical Officer, Reading Company, Reading Terminal, Philadelphia l. Pennsylvania. Representatives of the Medical and Surgical Section & on the Joint Committee on Railway Sanitation tib Dr. R. M. Graham (Chairman), Director, Department of Medicine and Sani tation, The Pullman Company, Chicago, Illinois. Dr. M. B. Clayton,-Chief Surgeon, Southern Railway System, Washington, D. C. Dr. A. M. W. Hurnh, Chief Medical Examiner, Pennsylvania Railroad, Philadelphia, Pennsylvania.