Document ydBrDOBQQ1Q8JNRxvnpJ768r

HE SECRETARY Sntcrstate Commerce Commission 3Htofjtngton, 3B.C. 20423 I, SIDNEY L. STRICKLAND, JR., Secretary of the INTERSTATE COMMERCE COMMISSION, do hereby certify that the attached is a true copy of the Association of American Railroads Proceedings of the Thirty-Eighth Annual Meeting of the Medical and Surgical Section, held at The Edgewater Gulf Hotel, Edgewater Park, MS, March 24-26, 1958, the original of which are now on file and of record in the office of said Commission. IN WITNESS WHEREOF I have hereunto set my hand and ffixed the Seal of said  ME 07 /c -.:q *'13 ^ '-7 '''.''K j: ; ' w'. V., . ; v v. \5' ' *>, ;*' ' ;: V' ; .. -: '-:v '. y-;.- ^,V.:;yVr;;^ -yr- ' 'v.& Vc`r>':' ,**, /<'-? g$Mfe ; :.'Asso4latlon 'ofA American Raifroadf' <v% * * *` '* * .,. . r , /^^'PROCEEDINGS > ^.0* JH6. ' THIRTY-EIGHTH ANNUAL MEETING Cit TWP ; '.tX.y.K.v'M V'!'; * V^'v ^ if MAY 1.3196Q|fcx4xS# s^tSP ^ -i ..... nfirt*v- // 2.1 !$~ /f-S / -X. 6 /</^S *3 1 Association oC Ar. Board of Dir Officer*____ Operations a' Operating-?: Burch, Dr. G. B-, Carney, K. A., Ac Chairman I. Gold Committee of Dit Committee on f )> ' Rejiort of.. ; i Committee on LiiRcjxiri of___ Committee on Fir- Report of___ Committee on .\F- ConunitU-*- on -No- Committee on Tru I Hcjiort of.. .. Crawford, Dr. Stm Eve, Dr. Duncan: [ Hollo, Dr. V. W., .* Koch, Mr. Eugene Medical and Surgiv Officers of Sect Officer* of Sect' Election of Me: Election of Chu Representative; Rules of Order Medical Film Oomn OchHncr, Dr. Alton, (juattlc-baum, l)f- J Report of Secretary. Representative? of N on Railway San. Report of____ Serious of Annual -V Monday Momin Tuesday -Morron Wednesday Mor Special Medical-Lega Report of___-- PROCEEDINGS OF THE THIRTY-EIGHTH ANNUAL MEETING OF THE Association of American Railroads MEDICAL AND SURGICAL SECTION HELD AT THE EDGEWATER GULF HOTEL EDGEWATER PARK, MISSISSIPPI MARCH 24-26, 1958 INDEX Association of American Railroads: Page Board of Directors____ ________ _______ ______ ___ _______________ Officers.......... ....................................... ............... .......... .................... ....... Operations and Maintenance Department.......................................... Operating-Transportation Division Officers........................................ 5 5 6 y Burch, Dr. G. E-, Address by:.......... ................. _....... ....... .......................... Carney, K. A., Address !>y:_.......................................................................... Chairman I. < Mldowsky, Address by:............ .............................................. Committee of Direction........ ................. Committee on Developments Hi-ullifig from Physical Examinations ... Report of....................................................................................... ............. Committee on Disability and Rchnbililatiou................ Report of..................................................................................................... Committee on First Aid_............................ ............... --............ --........... Report of....... ...................................................... Committee on Medical Aspects of Air Conditioning of Cara...... ........... Committee on Nominations, Report of................................... Committee on Trauma-................................................ Report of----............................................................................................ Crawford, Dr. Stanley, Address by:............................................................. Eve, Dr. Duncan: presenting Report of Committee on Nominations.... Hollo, Dr. V. \V,, Address by:....................................................................... Koch, Mr. Eugene K., Remarks by:........ .................................................... 56-60 17-51 (6-19 6 7 2t>--37 6-7 42-15 7-8 24-26 7 39--10 7 21-24 07-76 39-40 20-21 SO Medical and Surgical Section: Officers of Section and Personnel of Committees 1957-1958_____ 6-S Officers of Section and Personnel of Committees 1958-1959_____ 99-94 Election of Mernijers to Committee of Direction.............................. 10 Election of Chairman and Vice-Chairman......... ................................ 52 Representatives attending Annual Meeting.............................. 13-15 Rules of Drdi>r............. . ........................ ................................ 9-12 Medical Film CornmiiP'v-...................................................... DcIwut, Dr- A.ton. Addre-s by:. . . ... Quultlchauni, Dr. Julian K., Address by.............................. ... Report of Secretary....................................... Representatives of Medical and Surgical Section "it Joint Committee on Railway Sanitation................ Report of...... .............................................................................................. S '0- Hi) 53-56 19-20 8 90-91 SrMwmauf Annual Meeting: Monday Morning, March 24 _ ........................... .......................... Tuesday Morning, March 25 --........ ... . ........................... Wednesday Morning, March 26................................................... ........ 46 39 61 Special Medical-Legal Research Committee........................................ 8 Report of......... .......... ............-.............. -................................................. 62-65 ui 1 .v. .lt . `*$0% m. H-t fey - `m ASSC i Daniel P. Gregory Walter J. I William M R. G. MaA. II, (ni DijiAtW. M. Kri P. A. lloJJ,. J. timer M Robert S. i; S. J. Strong R. E. Keefe W. T. Fane-. D. C. R. L. Dearm Harry A. Dei j F. 0. Gurley, | Topck;i t Ben W. Ilcuie: Illinois. Clark Hunger Missouri. D. B. Jenks, I' Illinois. W, A. Johnstoi P. B. McGimu cllUi-Otts. II. C. Murplr BurlingT"!' A. II. iVrliiinn. W, Thomuj- Ili> C':rnlin:i L>. J. Urn-sell, 1'. H. E. Simpson. John W. Smith. A. K. Stoddard. i J. M. Symes, Pr John E. Tilford Kentucky. W. J. Tuuhy, PrH. W. Vou Willct L. L. White. Ck road, Cleveij 7 Ltvfir*. . LTcvfc*; .4V 8 Association of American railroads (March, 1968) Officers Dani'-I P. Loomis. Pri-fideht. Gregory S. Prince. Vieo-Pn-ddvnt and General Counsel. Walter J. Little. \ font. William M. Moloney, General Solicitor. Tl. G. May, Yioe-Pn-ddenc Operations ami Maintenance Department!. A. R. Seder, Vice Pp>id*tit t Finance. Accounting. Taxation and Valuation Department;. W. M. Ki ller, \ ice Pn -id<-fit . Ifej-eardij. P. A. Hollar, Vice-President--Assistant to President- J. Elmer Monroe. Vice-Pre-idcnt and Director `'Bureau of Railway Economics). Robert S. Henry, Vice-Pr<iddont (Public Relations Department). 9. J. Strong, Secretary-Tfi-n.-furer. R. E. Keefer. Assistant Secretary-Treasurer. Board of Directors W. T. Faricy, Chairman (cx-olficio), Transportation Building, Wn.-tiingtoa tj, D. C. R. L. Denrnumt, Pv-idenj. Missouri 1`aeilie Line*. St. Louis, Mi--ouri. Harry A. DeButts. IVddcHt, Southern Railway Svstetn. Washington. D. C. F. G. Gurley. Chairman "f the Hoard and Chief Executive Utficer, Atchison. Topeka ik Sar.ta F Railway. Chicago, Illinois. Ben W. lletneman, Chairman, Chicago-and North Western Railway, Chicago 6, Illinois. Clark Iftingcrford, President, St. Loui.vSaii Francisco Railway, St. Louis, Missouri. D. B, links, President, Chicago, Rock Island and Pacific Railroad, Chicago, Illinois. W. A. Johnston. Pr.-tdeti?. lUin-n ' `ittr d R.iilro id. ( HR ago. I.'iiia.is. P. H. McGiimi-, Pn-ident. Ho-i-ai aid Maine Rnlioad, Bo-ton 1), Ma--a- chu.-etfs. II. C. Murphv, Pn-ident ml Chairman, Executive < 'omimttee. Chicago. Burlington Quincy Railroad, (In-'ago tj, Illinois. A, E. I'l-riiuan, President, N-.v York t'er.trid S' N'.-.v Y>-rk. New York. W. Thomas Riec, Pre.-ideiit, Atlantic ( oast Line Railroad. Wilmington. North Carolina. D. J. Russell, President, Southern Pacific Company, Suo Francisco, California. II. E. Simpson, President, Baltimore J: Olfio Railroad, Baltimore, Maryland. John W. Smith, President, Seaboard Air Line Railroad, Norfolk, Virginia. A. E. Stoddard. President, Union Pacific Railroad, Omaha. Nebraska. J. M. Symt3. President, Pennsylvania Railroad, Philadelphia, Pennsylvania. John E. Tilford. President, Louisville it Nashville Railroad, Louisville, Kentucky. W. J. Tiiohy, President, Chesapeake and Ohio Railway, Cleveland 1, Ohio. If. W. Von Wilier, President, Erie Railroad, Cleveland 15, Ohio. L. L. White, Chairman of the Board, New York, Chicago it St. Louis Rail road, Cleveland 1, Ohio. 5 6 .1 iSiXHUiori of Aimncan Railroads Pr> OPERATIONS AND MAINTENANCE DEPARTMENT R. C. M.iv. \"ii-('*pp-i'li,nt Dr. S. M. EnglBh, M D. it O. (\-ntr-it OPERATING-TRANSPORTATION DIVISION W. C. IViker. Chairman f\. M. Talh-un. Vin-f'huinnnn A. I. Cili^kc. Executive Vic,c-< Ti:i irrnan Dr. J. W. Houk. Me.. Terminal Tower. Dr. R. S. KictTer, Chi.Missouri. Dr. Harvey Nelson. OFFICERS AND PERSONNEL OF COMMITTEES OF THE MEDICAL AND SURGICAL SECTION FOR THE YEAR 1967-1958 I Dr. I. (:!!.;\v*ky. C. .inrun Building. Minn<- Dr. O. Carle Wight. U iinl.Mir Station. Dr. M. B. ( Livtoti. Vice-Chairman F. J. Parker. Scrrra.iry Dr. B. \Y. Stoi-kwi'H < Committee of Directioa Railroad. TOO !)> Dr. R. G. CarothefH. Dr. I. Goidowsky, Chairman Railway, Cinema . Dr. M. B. Clayton. Vice-Chairman Dr. Duncan Eve. Chi': T.-rm expires in I'JyS) Dr. R. M. Graham. Dim-tor. Department of ,\(iand Sanitation, The Pullman Company, loo North Cm.il SL, Chicago 6, Illinois. Dr. C. F. iloiton, Chief Surgeon, Central of Gi-orgia Railway, Savannah, (horgia. Dr. J. K. .Stack, Chief Surgeon, Chicago,v Xoith We-tern Railway, IJ7 North Clinton Street, Chicago Illinois. 2001 Have* Sire'" Dr. J. XL Gandy, Cluei Texas. Dr. C. F. Holton, Cl. Georgia. Dr. Southgate l.vigh, Box Riclmai Dr. W. E. Miihler. ( Dr. G. K. Cushman. Chief Surgeon, Western pacific Railroad, 526 Mission Street. San Francisco. California. -Term expires in 1259) Dr. M. B. Clayton, Chief Surgeon, Southern Railway System, loth and K Streets, N. W., Washington. D. C. Dr. K. E. Dowd, Chief Medical Oificer, Canadian National Railways, Montreal, Due.. Cmada- Dv. V. W. if./!'!, f i.ii'f Surj'"in, St. {. .uis-Sm i'r Hailv-av, St- Louis. Mi.-<uri. Dr. J. Holer Winner, Chief Surgei.n, B---emer >x Like Erie Railroad, o25 William P<n Place, IV.t.-nurgh, Peim<rlv.inu. Cleveland 15, Ohio Committee on Deve Dr. W. J. Longeway {L way. 520 Mctropoi. Dr. J. J. Brandabur. C Huntington, West \ Dr. B. I. Dc-rauf. Ci.. Mimm-'ji a. Dr. J. R. Knowles, t Mas.-eichu-ctta. Dr. J. M. f.. JcnHeo, Chi (Term expires in Dr. R. J. Bennett, Chief Surgeon. J'gin, Joliet and Eastern Railway. 208 South LaSalle St., Chicago, Illinois. Dr. L Goidowsky, Medical Director, Central Railroad Company of New Chicago, Illinois. Dr. R. S. Wr-Mline, Chi West fiJrd Street, t "> (One Vacancy) Jersey, Jersey City, New Jersey. Dr. W. E. Mi.-Mer, Chief Surgeon, Lric Railroad, tlos Republic Building, Cleveland \5, Ohio. Dr. B. W. Stockweil, Chief Surgeon, Detroit and Toledo Shore Line Railroad, 3919 John R. Street, Detroit 1. Michigan. ': ' Committee on Dr. R. M. Gtibara pCbair tion, The Pullman C "Jf-'y ' Dr, ,Vf. B. Clayton, Chi*/' ., Streets, N.W., Waalu Committee on Disability and Rehabilitation Dr. James K. Stack (Chairman;, Chief Surgeon, Chicago <U North Western k.i'V Dr. K. E. Dowd, Cbm _ Montreal, Qua., Can.. Railway, 127 North Clinton Street, Chicago 6, Illinois. Dr. J. F. DePree, Chief Surgeon (lines West), Chicago, Milwaukee, St. Paul <i Pacific Railroad, 1056 Medical and Dental Bldg-, Seattle l, Washington. - C. Olson (Chainm - Stony Island Avenue. Association oj Amo-ican RmU'nus OPERATIONS AND MAINTENANCE DEPARTMENT R. G. M.iy. Vi<---P|c -i,]i-nt OPERATING-TRANSPORTATION DIVISION U'. C. Bilker, Chairman E. M. Tolicson, Vice-Chairman A. I. Ciliskc. Executive Vici*-('h.iirmnn OFFICERS AND PERSONNEL OF COMMITTEES OF THE MEDICAL AND SURGICAL SECTION FOR THE YEAR 1957-1968 I)r. I. < -kv. i nun Dr, M. U, < lay ton. \ t, ui man F. -J. Parker. SeiT'-Mry Committee of Direction Dr. I. Goldovsky, Chairman Dr. M. n. Clayton, Vice-Chairman '.Term expired in 11)5$) Dr. R. M. Graham. Director, Department of Medicine and Sanitation, The Pullman t umpany, ld.7 North C 'anal St., Chicago *>, Illinois. Dr. C. !'. Holton, Chief Surgeon, Ci-ntral oi Gi-orgia Railway, Savannah, Georgia. Dr. J. K. Sta' k, Chief Surg-<m, Chicago w North IV.-i.-m Railway, {27 North Clinton Sfrcet, CLhxigo o. Illinois. Dr. G. P. Oishtuan. Chief Furg'.-<<, Wv^ti-ru P.wifn: Railroad, 3--0 Mission Street. San Francisco. California. *r Term in RV/J) Dr. M. R. Clayton, Chief Surgeon. Suuth'Tii R.ula iv System, T3tti ami K .Streets, N. W., Wa.-liinglori. 1). Dr. K. L. Dowel, Chief Medical Uilicer, Canadian National Railways, Mont n il, Otte., I' i.'uid.i. Dr. V. V 11>:!<!, ( r.i*f >'iri'"oii. .-r. I.- -iii--> m rnM-i-np R ulv av, St. Louis. Mi.-soiiri. !>r. J. !lul-r Wagner. Chief Surgi'm, P..-'-ni`*r .x lak.* l-.iie R ulmd, .725 William P.-nn PI.mv, Pi'l.-Lurgh, p.-nn-;. K.uu *. (Term expires in !9*>0) Dr. R. J. Bennett, Chief Surgeon, I'gm, Joliet ami Eu.-.t<vn Railway, JOS South LaSalle St., Chicago, Illinois. Dr. I. Goldovsky, Medical Director, Central Railroad Company of New Jersey, Jersey City, New Jersey. * Dr. W. E. Mishier, Chief Surgeon, Erie Railroad. (JOS Republic Building, Cleveland 15, Ohio. Dr. B. W. Stoekweil, Chief Surgeon. Detroit and Toledo Shore Line Railroad, :t9l9 John R. Street, Detroit l, Michigan. Committee on Disability and Rehabilitation Dr. Janiea K. Slack (Chairman), Chief Surgeon. Chicago it North Weetern Railway, 27 North ( iiuton .Street, Chicago H, Uliwiut- Dr. J. F. DePree. Chief Surgeon (Line* West), Chicago, Milwaukee, St. Paul Jc Pacific Radtoad, 1G5S Medical and Dental Bldg., Seattle 1, Washington. Pr< Dr. S. M. English, M B. & O. CVmrai Dr. J. W. Houk, Me. Terminal Tower. Dr. R.S. KicsTer, CL. Missouri. Dr. Harvey Nelson. Building, Mime Dr. O. Carlo Wight. U'ijnl-or Sf.iiao.. Dr. B. W. Stoekuvil : Railroad, ~i>) !)>< Dr. R. G. Carother*. ( Railway. Cincinr,, Dr. Duncan Eve, Chi-: 2001 Hayes Strcc* Dr. J. R. Gandy, Clue: Texas. Dr. C. F. Holton, Cl. Georgia. Dr. Southgate I>eigh, Box lr'>20. Rich mot Dr. W. I'. .Mi.diler, (" Cleveland 15. Ohio Committee on Devr Dr. W. J. I/ongewnv i< way. -V2U Mvtr>j. Dr. 1. J. UranUabur. t ' Huntingtoo, West \ Dr. B. I. Dcrauf. Mtmi.-- .ta. Dr. J. R. Knowles, < Max.-whii'cits. Dr. J. M. L. Jensen, Chi Chicago, Illinois. Dr. R. S. Westline, ChiWest 03rd Street, O (One Vacancy) Committee on ? Dr. R, M. Graham (Chair tioo. The Pullman C Dr. AX. B. Clayton, Chi , Btrects, N.W., Wash Dr. K. E. Dowd, Chi* _ Montreal, Qua., Can. P.r' Olson (Chairau Stony Island Avenue. epartment ^rvisiorf .ri.irt ITTEES OF THE HE YEAR 19C7-1968 ,uc and Sanitation, The i *>, >. _.la , /, Savannah, 'em Hiiiiwiy, l7 North ; Railroad, 5-6 Mission ;v System, loth and K ,n National Railways*, .. . i: . v . St. I.-'Ui". i ri<* It okoad, ->25 Kasti-rn Railway, 208 ad Company <>t NeW iig Republic Building, io Shore Lino Railroad, utioo ago & North SV.*stern nuia. M ' -e. St. Paul A c.-a, .V^hingtOQ. Pr-veoiinqi of \fediral and Surgical Action 7 Dr. S. M. English, Medical and Surgical Director, Baltimore ,v Ohio Railroad, B. \ 0. Central Bunding. Room 217, Baltimore l, Mariund. Dr. ./. W. flook, Medical Director, New York, Chicago a: St. Louis Railroad, Terminal Tower. Cleveland 1, Ohio. Dr. R. S. Kinder, Chief Surgeon, Missouri-Kuflsas-Te.xas Railroad. St. Louis I, Missouri. Dr. Harvey N'Non, Chief Surg'-on, Soo Line Railroad, Itd-'l Medical Arts Building, Minneapoli.i J, Mume-ota. Dr. <. Karle Wight. C'hiet of Medie-d Services, Canadian l' icilic R.ula i.-. Wind-.r M.tUuii. Montreal, ij'ii'., Canada. Committee on Trauma Dr. B. W. Stock .veil i (.'hairman i, Chief Surgeon, Detroit 6: Toledo Shore Line Railroad, 700 Doctors Building, 6019 John R. Street. Detroit, Michigan. Dr. U. (j. Carothers. Chief Surgeon, Cincinnati, New Orleans *fc Texas I'acilie Railway, Cincinnati 2, Ohio. Dr. Duncan Eve, Chief Surgeon, Nashville. Chattanooga fc St. Louis Railway, 2IX)1 Haye.H Street, Nashville L Tvnnc-siee. Dr. J. R. < Lind)-, Chief Surgeon, Texas & New Orleans Railroad. Houston 1, Texas. Dr. C. !'. Holton, < 'Lief Surgeon. tVrilnl of (h-orgia Railway, Savannah, (Jeofijia. Dr. Southgate Leigh, -Jr., Chief Surgeon, Seaboard \ir fain' Railroad. I'. (I. Box i'T'ft, Ri.-iiuii.rul I S. Vhgiiii.i. Dr. W. K. .Mi.-h!er, Chief Surgeon. Krio Railroad. '>LS Repui/.ic Building, Cleveland 13, Ohio. Committee on Developments Resuiting from Physical Examinations Dr. W. J. Loticmvny (Chairman), Chief Surgeon. Colorado v Southern Rail way, 3_'U Metropolitan Building, Denver, Colorado. Dr. ./. .1. Br iU'tdiur, ( l.nd Mdieul Examiner, Che.-upvake X Ohio Railway, Elimtington, Wri Virginia. Dr. B. L l>eriuf. `i Sui.-voti. Noi'.e-rn Punic Railwai-. St. Paul 1. s 1 i11: -- *' a. Dr. /. R. K'ri'.Aii-, Bi- f .-urgeon, ll-lmi A. Maine ILoiri'id, Wi-mn. 'd |. >.l|-e<t,. Dr. J. M. I.. hn's-n, t Lief Surgeon, < Virago, Ru<'k 1 -land Jc P.uihc Railroad, ( `hivago. Bliin.i. Dr, U. S. We.ilme. Chn-i .-urgeon, Chicago & Eastern Illinois Railroad, 634 \Vo*t 'i.'lrd Street, Chicago, Illinois. lOne Vacancy; m Committee on Medical Aspects of Air Conditioning of Cars Dt. R. M. (iriham rChairmani. Director, Department of Medicine ;ttui Sanita tion, The Pullman ('ompany, BJ3 North Canal Street, Chicago 6, Illinois. Dr. .M. B. Clayton, Chief Surgi-on, Southern Railway System, lath and K. Stm-rs. N.W., Washington Ri, D. C. Dr. K. K. Dowd. Chi**t Mi-diral Olftcer, Canadian Nutional Railway*, Montreal, Due., Canada. Committee oo First Aid Dr. E. C. Olson 'Chairmam, Chief Surgeon, IUinoia Central Railroad, 5800 Stony Ldand Avenue, Chicago, Illinois. i s_ * rzr:-- 8 Asiocialion of American Railroad.t Dr. V. W. Hollo, Chief Surgeon, St. Louis-Sun Francisco Railway, St. Louia, Missouri, Medical Film Committee Dr. R. S. KiefTcr (Chairman;, Chief Surgeon, Missouri-Kansas-Texas Rail road, St. Louis I, Missouri. Dr. G. W. Benjamin, Chief Medical Officer, Western Maryland Railway, liillen Station, Baltimore 2. Maryland. Dr. G. F. Cushman. Chief Surgeon, We.-tern Paciffc Railroad, 52G Missiou Street, San Francisco, California. Dr. A. Xygood, Chief Medical Examiner, Chicago & North Western Railway. 12" Xortt; Clinton Street. Chicago 0, Illinois. Dr. J. It. Win-t"n, .-ytem .M- iu-;<i Director. Atchison, Topi-kn ,v .Suita Fe Itailwm, sii K. Jackson Boulevard. Chicago, lllirioi--. Advisory Members from Committee of Direction In. It. ,1. B< iiiiei t. Cliff .-myon. Elgin, Join! ;.n i La?tern Railway. 2(ts South Dr. R. M. Gi.ili.iiu. Runctoi. D: patsmuii of Mouieitie and Sanitation. The I'u 11 in a n Coinjj.iriv. ]i.n North Canal Street, Chicago. Illinois. Dr. V. W. Hollo. Chief Surgeon. ,-i. Eoui.--S.iti Francisco Railway, Si. Louis. Missouri. Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation Dr. R. M. (ii.iiiam 'Chairman. Joint Committee on Railway Sanitation , Dii'-etoi, 1 ) ;<amnerit M--iicjw: and Sanitation. The I'ulimaii Com pany, 1G5 North CaJial Street, Chicago, Illinois. Dt. M. B. Clayton, Chief Surgeon, Southern Railway System. 15th and K. Streets, NEW., Washington 13, l). C. Dr. A. M. \V. liursh, Assistant Medical Director, Pennsylvania Railroad, 15 Xortii 32ud Street, Philadelphia 4, Pennsylvania. Representatives of the Medical and Surgical Section on the Special Medical-Legal Research Committee Dr. W. E. Mishler (Chairman;, Chief Surgeon, Eric Railroad, 608 Republic Building, Cleveland 15, Ohio. Dr. R. J. Burnett, Chief Sutgvoti. Elgin. Joliet and Eastern Railway, 20S South LaSalle Street. Chicago. Uhinn-. D: I < inldoii - v, Mi du-.d 1).: i !.,(. (' hi r. I Railrf>ri>| n! Ni w Jit-w, JiTm-v City, Ni w Ji IM'V. Dr. llai\<-> Nil -on, < lii>'l Smc-'iti, .'-"i Liih- Railroad, 1153 Medical Art.' Building, Miiiln aj.oh' J. .Minin ,-ota. I > f ASSC 1. R repre-e;. Chief M. Expre-.in thL .- 2. AF iaboratu thereof An Allii. Road re; 3. T!.aod Serf fa) VICEiD nnnot su (b) the D: appro lei terrm Eng:,: from 1 for thr The shall comm, untii : In Rureu him, ;. Provi; of the St. Louis. ' xas Raii. Rahway, MlrMUlJ i Railway, Santa l-'e . JOS South ation. The . S us, - imtatioo), ..man Com- `;h and K. . Rahf-.id, ' ! public li-A-ay, JUS r-.-v, Jersey `dical Arts Proceedings of .\[edieal and Surgical Section 9 ASSOCIATION OF AMERICAN RAILROADS OPERATING--TRANSPORTATION DIVISION MEDICAL AND SURGICAL SECTION RULES OF ORDER 1. REPRESENTATION: Aa provided io the Plan of Organization, the representation of Member Roads in the Medical and Surgical Section shall be Chief Surgeons or other persons engaged in a similar capacity. The Railway Express Agency, Inc., and the Pullman Company are eligible for membership in this Section. 2. AFFILIATED MEMBERS: A icpre-entative of an organization col laborating or cooperating with the S-rti-.n may Iwomp an Alliiiated Member thereof upon the approval of his appluatmn by 'he OuituuUru i Direction. An AiUliated Member shall have the rights and privi' -ges accorded a Member Road representative, except vo'iug or the holding of oiiice. Officers and Committees d. The oificers of the Section shall eon.-i.st of a Chairman, Vi- e-Chainnan and Secretary. 'il \- provid'd in the Pl.m <jigaiii/1>ion, 'ho CHAIRMAN ml VICE-CHAIRMAN -L.il I......!-' : b. >u- m.i'........ f >ir- - it - Ii.iii,i,,i>bip. Ill- If Ii-im- ..f ... 1 isi-ill .,r. At r:i..n will not -it.......d liitn.H-li'. (b) The SECRETARY will be a I ! bv lie- tb'e-rcl t oiariiini ol the Division, iiis salary -hall be named by that. ('uminilice, .-ubjvt to the approval of the Vice-President, Operations and MaiiUetiami: Department. (c) T'ht: COMMITTEE OF DIRECTION will consist of twelve members, territorially representative as far as practicable--one each from New England and Canada: four from the East; two from the South and four from the West--elected as hcrcinuitcr prescribed, each of whom .-lull serve ` for three years. The terms of otfice of all elective members of the Committee of Direction shall expire at the conclusion of the Annual Meeting. Vacancies in the committee membership shall be tilled by ap|K)in(mcnt of the Committee until the next election. In uddition to the above, the Surgeon-General of the United States Bureau of Public Health Service or a representative to be designated by him, and a representative to be designated by the Conference of State and Provincial Health Authorities of North America shall be honorary members of the Committee of Direction. _tt rtrt i't-'- =* m /i;* 10 Atsociolion of Aromrfln ffniirontit The Committee of Direction will select from it* elective membership a Chairman and Vice-Chairman of the Section, whose. term* of office shall be one year. A Chairman will not sum-i-d hinmelf. (d) The Standing Committees of the Section will be aa 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 Committee on First Aid Medical Film Committee Th- representation of Member 1 {<;><i-- on il.r -< committees will be, k* far a* is piaciieablr. trrutorialK m l< > ie.|, in :ii>).ri>\iin.itolv tie- am'hoo- a- tliat of ti,e t Dainnu* '- <>i 1 >ir.* 11,in. pi i.-"Hin I I" bo tinned inch year by the- Commii ut of Di:e<nnn imie.ebinU h i< -!h.w iiig adjournment fit tin- Animal Me '.inv. Duties of Officers !. lb'' CHAIRMAN shall have general sujK-rvision over the affairs of the Section and shall pr'-id>- at n.eeun"-- o: the Section arid at meeting.- of the Committee of Direction. 5. The VICE-CHAIRMAN', in the absence of the Chairman, shall perform the duties of the Chairman and such other duties as may Ik- assigned. G. (a) The SECRETARY shall perform the usual duties of that office ami such other duties as may rv assigned to bite, by the Chairman. (b) IN- shall receive six week-- in advance ol the Annua! Meeting each year the report qs the Committee on Nominations, us elsewhere provided for, and will submit to Iho membership at the Annual Meeting the nomina tions contained in that rejvort. to fill the vacancies in the membership of the Committee of Direction. He shall announce the result of the election promptly to the members. Duties of Committees 7. The COMMITTEE Of DIRECTION shall: (a) Exercise general supervision over tin- interest* and affairs of the Section. tb) He empowered to act on behah of the ."ertioi, in the interim between meetings and shall submit at ouch n.evtinv ;k n-p<,rt cine;n,f . action-. Ui lCxati.me and decaie whn> imrtn.'t o; paper- and reports .-!i:. 11 he MiMi.r, ii-{ at t n<- m< 1 jn^- h sb bl d- le-mine w ha h. u any. ol tie sublet1- pir-eiiie-l b. the various commit lev--, tiinll be reiernd to the General CumimOev ot the Division. (d) Ap|Kiint two months in tidvaiu-v ot the Annua! Meeting each year a Committee' on Nominations, consisting of representatives of five Member Roads, who shall not he members of tin- Committee of Direction. (e) Apj-oint additional roimnittee* :is required. (0 Submit to the Chairman, General C'ummiUec, detail of couitinplated financial riquiremem.- for emnim-ting the work of the Section ua required or as vailed for by that official. > , ! [ i 1 ; { j ( (g) Call An General Come (h) Call nw to each memb request, in wn 8. The COMM shall report to the mg of each year, place the four rr that year, and to The duties of tl 9. ro.M.Mm REHAB HITATIO tiuiis, on such mi'* civncy of railro.i' rehabilitation of tion of function. 10. coMMirr and report on the (a) Diagnosis of tr report forma, (d) 11. COMMITTJ RESULTING FRO report, with recoa periodic examinatio rant, the recommen the forms used in 12. COMMITT OF AIR CONDI! in its relation to departments hale 13. COMMITTi: study and tp<mrt, tions for railroad matters involving U. COMMIT! concerned with e medical films for 16. VOTING A viva vocc, by rvii entitled to one vo seated shall be re otherwise ord-red. mittc-c of Dirtetron the raakiug office at any meeting. .1--o.-arwjvtmm gwn"" i . : membership a .ii oilice shall be .uUowa: 1 .-ienl R.xamina* .g <i ('.iM i-s will be, >o far he same proporo be named each z adjournment of vhe Sira of the /. ns '<s of the . .ui, -hall perform a."ignvd. <>f that office and ji. .ual Meeting each /where provided 'ing the nomina- e raeinberstup of ; t .,i *n* 'lection m! t:f *irs of the e interim between . .ng its actions. tior.it, papers and t'-rnime which, if dull bo referred riing each year a a of five Member nrectioo. ui of 'utemplated ,-ct -squired Proceedings of M-dicnl and Surgical Section 11 (g) C.dl Annual Meetings of the Section, subject to the approval of the General Committee of the Divi.-ion, if in its judgment conditions warrant. (h) Call meetings of the Section, upon not less than thirty days' notice to each member. It must call special meetings oi the Section upoo the request, in writing, of a majority of the Member Roads. K. The COMMITTEE ON NOMINATIONS, appointed ;*.< abov- jirt-rrib.il, shall report to n>- ."ViTeiary at Ir.i.-t six >fks in advance of the Annual Meet ing of each \ ir. .it l-a.-i tan non i mat ions lor <urh ini j)ii'ting vacancy '<> re place the four n.min is of ihi: t'innnu-e >.i Iiinriion '.\ho>v '< nn.s .-\pire tbat year, and n, uti .-.ny varaiicy. The duties ot the Standing (`imuuil'-es shall be .ui follows: 9. COMMITTEE XO. 1--The COMMITTEE ON DISABILITY AND REHABILITATION shall study and report, with suggestions 05 recommenda tions, on such subjects that have to do with the physical efficiency or ineffi ciency of railroad employes. H shall also consider ways and moans for the rehabilitation of injured or incapacitated employes and the complete restora tion of function. 10. COMMITTEE XO. :* T im COMMITTEE ON TRAUMA shall study and report on the treatment and transportation of fracture cases including (a) Diagnosis of fractnri-, ((<) i ir.-t. .,id and sr:in>irtntioii .-piint.i, m) Em" ure report forms. (d> X-ray work in connection with fractures, and similar -unj'-ct.i. 11. COMMITTEE XO. 3-The COMMITTEE ON DEVELOPMENTS RESULTING FROM PHYSICAL EXAMINATIONS shall amdvze atid make report, with recommendations or suggestions, on data made available by periodic examinations, etc. It -lull study and revise as conditions may war rant, the recommended staudards covering physical examinations as well as tile forms used ;:i LoniKclion therewith. I.'. ruMMEITEi: Mr. i T'..- COMMITTEE ON MEDIC.VL ASPECTS OF AIR CONDITIONING OF CARS -1. til .-uidv <nd i.-r,rr ..u ..uv-a in !'.* relation to !.> ic-aith and 'mfort of Tavi-h-ri, 'onporunrg wi<h '/her departments li.iiwiing inaUrrs relating >0 air 'onditionnig of nun.-.'ia iii. 13. COMMITTEE NO. 3-The COMMITTEE ON FIRST AID -hall -'udy and r--j>art, with -inrgr-lioni "f r`T'>iriOicndati'>n.i, no fir-t aid m-'ructions for railroad employes, a standard firt aid packet, etc., and such other matters involving first aid as relate; to railroad operation. 14. COMMITTEE XO. G--The MEDICAL FILM COMMITTEE snail be concerned with such .study as required of matters relating to availability of medical films for railroad use. 15. VOTING AT MEETINGS OF SECTION: (a) Vote may be taken viva voce, by ruing, by roll cod or by ballot. Each Member Road .-hall be entitled to one vote. The vote of the majority of the Member Roods repre sented shall be required to decide any question, motion or resolution, unless otherwise ordered, (h) Voting for candidates for membership on the Com mittee of Direction shall be by ballot, (c) Unless otherwise designated by it, the ranking officer will be recognized as the Voting Representative of a road at any meeting. 1 16. LETTER BALLOTS may ! taken ujkio any subject by order of the Committee of Direction and must tx* tuken on all questions atTectiog physical property. The voting power of the Member Road* shall ! projKvrtionate to the ownership of mil' s of road. J7. ORDER OF BUSINESS: The order of bu-iness at meetings of the Section shall, unless otherwise directed by a majority of the members present, be as follows: Approval of minute* of last meeting Reports of Standing Committees Reports of Special Committee Report <>; Telli :.* 1 'nfirnVhed Ihi-tm-- New IS. Robert's Huh- ; Cider -1-...' oaiti. th< proeecthne* i<f this Soetton. itiiluding amendment to th<-<- Rule- nt Order. \ 'V ,~g t | { j t J ASSOC! ATIO MED The following were pr> Members At'.'hi.-wn, Topeka A r way--......................... Atlanta & St. Andrew* Alton 4: Southern Railn Bamberger Railroad______ Bangor A' Aroostook Ra. Bessemer 4: Lake Krie H Birmingham Southern it Boston 4: Maine Railroad. Buffalo Creek Railway.. Canadian National Rail Canadian Pacific Railwi Central of Georgia Hail" Central Railroad of New Chesapeake 4 Ohio RaiD Chicago, Burlington A road............................. Cliinico, Milwaukee, St. Railroad........................ Chicago fc North Wcstot Chicago, Rock island & road................................ Chicago, South Shore A Railroad....................... Colton Belt Railway___ . ^ub. a t^rrvjw':-- i by order of the lilcctiuit phy deal proportionate to _ m<'>-hiii's <>i the n.-uihrn pre-cut. i of this Section, Proceedings of .\U-iical and S'trqizol Section 13 Association of American railroads MEDICAL AND SURGICAL SECTION Eyewater Gulf Hotel Edgewater Pack, Mississippi March 21-26, 1368 The following were present: Members Representatives Atchison, Topeka <fc Santa I-'u Rail way......... ................................................ Dr. J. it. Winston, Medical Director, SyMtfjn. Dr. G. Wendell Olson, Local Surgeon. Atlanta & St. Andrews Hay Railway - Dr. John T. F.UU. Alton .t South<-rn Railroad Dr. V 1`. Siegel, M'-diral Dire,'for. Bamberger Railroad........... ....................Dr. SjM-ncff Wright, Surgeon, Director. H jigor .fe Aroostook R dim id... .. Hr. J. II. Johnson, (.'Wirt' Surgeon, Bessemer & Lake Eric Railroad........... Dr. J. II. Wagner, Chief Surgeon. Birmingham Southern Railroad...........Dr. L. Velton,. C'bivf, Orthopedic Sumery. IkiaUKi t Maine Railroad .................. Dr. J. R. Knowlrs, Chief Medical (.'i.'i-iiltant. Buffalo Creek Railway ......... Dr. W M. Mi.-hler. Chief S'lTgcon. ('.at,n'.tan X;its>it.l :! :.i.v i\ - i>r K i 1 -I. (he a Med h a i Oliver, ('.ui.ulian Pacific l.'.uiw iy Dr. <I. i.uir Wight, Chief u( Medical '.rvirrv i 'cntral of Georgia Railway . ... Dr. I!'. Holton, Chief Surgeon. Central Hailroa'l of New Jcr.-cy...........Dr. I. (hifdow'ky, Medical Director. Cla-Mapeakc it Dhio Railway ..............Mr. J. J. Smole, Special Represent ative, Clucago, Burlington it Quincy Railtoad............... .........................................Dr. R. B. Kopncr, Chief Medical Officer. Chicago, Milwaukee, St. Paul iV Pacific Railroad........... ................... ............... Dr. R. Householder, Chief Surgeon, (I-inen Kaat). Chicago A North Western Railway....Dr. J. 1C. Stack, Chief Surgeon. Chicago, Rock Island .t Ru-ifio Rail........................................................Dr. J. M. U Jc-nsco, Chief Surgeon. Chicago, South Shore k South Rend Railroad...... .........................................Mr. J, M. Scahright, Claims Attorney. Cotton Bolt Railway..... ..........................Or. William Hibbitte, Chief Surgeon. n- & v'K' '{*-. & 2 \ 14 Astoei/Uiun of American Railroads Members Representatives Delaware, Lackawanna & Weateru Railroad.................................................. Dr. J. 0. MacLeau, Chief Surgeon. Detroit Terminal Railroad...... .............. Dr. B. W. Stockwell, Chief Surgeon. Detroit & Toledo Shore Line Railroad.,.Dr. B. W. StockweU, Chief Surgeon. Elgin, Joliet A Eastern Railway........... Dr. H. J. Bunnell, Chief Surgeon. Col. V. S. Adkins, General Claims Agent. Mr. H. L. Hackbert, Attorney at Law. Eric Railroad..................... ...................... Dr. W. E. Mishler, Cldef Surgeon. Grand Trunk Western Railway............ Dr. K. E. Dowd, Chief Medical Officer, Dr. B. W. Sloekwcll, Chief Surgeon. Illinois Central Railroad.........................Dr. E. C. Oinon, Chief Surgeon. Illinois Terminal Railroad____ _ . Dr. J. A. I-emlsvk, Medical Assistant to President. Kansas City Terminal Railway............Dr. G. Owens, Chief Surgeon. Lehigh Valley Railroud.--..................... Dr. J. S. Niles, Jr., Chief Surgeon. Louisville & Nashville Railroad............ Dr. Duncan Eve, Chief Surgeon. Misaouri-Kanaaa-Texas Lines............... Dr. R. 3. KiofFer, Chief Surgeon. Missouri Pacific Railroad--....................Dr. J. A. limbeck, Medical Assistant to President. -Monos Railroads...... ........-rv...--:.Di. L. T. fllahl, CiiM Surgeon: - New York Central System.....................Dr. R. A. Johnson, Medical Director. Norfolk 4 Western Railroad...................Dr. M. P. Moore, Medical Director. Northern Pacific Railway....................... Dr. B. I. Derauf, Chief Surgeon. Pullman Company................................... Dr. R. M. Graham, Director, Medicine and Sanitation. Seaboard Air Line Railroad--..............Dr. Southgate Leigh, Jr., Chief Surgeon. Soo Line Railroad.....................................Dr. Harvey Nelson, Chief Surgeon. Southern Pacific Company....... ............. Dr. V. M. Strange, Chief Surgeon. Southern Railway...................................... Dr. M. B.Clayton, Chief Surgeon. St- Louia-Suo Francisco Railway........... Dr. V. W. Hollo, Chief Surgeon. Terminal Railroad Association of St. Louis.............. .................. ..................Dr- J. A. limbeck, Medical Assistant to President. Union Pacific Railroad............................ Dr. W. Bale, District Surgeon. X>r. J. 0. Clanin. Dr. EL M. Petti*. Dr. R. 0. Porter, Surgeon. Dr. Spencer Wright, Consultant. Western Pacific Railroad....................... X>r. G. F. Cushman, Chief Surgeon. Winston-Salem Southbound Railway...Dr. L. ShafTncr, Chief Surgeon. > vit ueseotadve* cLean, Chief Surgeon, ockwvil, Chief Surgeon. K-kttfU, Chief Surgeon. emit, Chief Surgeon. \ ikin^, ( M-jK-ril Claims u kiTt, AUufiH'V at I.aw. hU-r, Chief Surgeon. vci. Chief Medical Officer, vck'vefl, Chief Surgeon. :on, Chief Surgeon. Ttbeck, Medical Assistant it. a, Cb'"* Surgeon, a, J ief Surgeon. rive, '__ ef Surgeon. :Tcr, Chief Surgeon. ibeck, Medical Assistant it. \hl, Chief Surgeon. \nson, Medical Director. ...re, M-'iical Director. ujf, Chief Surgeon. D ' tor. Medicine . :.,a. I., uii. .1: . I 'lift 'nrgcoii. . . . ! Surgeon. 'ngc, ('!..! Surgeon. ;. t.ifi. (.'i.ii.-f Surgeon, illu. Chief Surgeon. ;t:i:k, Medical Assistant ;t. District Surgeon, am. 11 is. rter. Surgeon. Wright, Consultant. -tur ' *hief Surgeoo. er, c. -urgeoo. Proceedings of .\fedical and Surgical Section 15 Also Present Members Representatives Association of American Raiiroads____Mr. K. A. Carney, Executive Vice- Chairman, General Claims Division, Director, Claims Research Bureau. Mr. F. J. Parker, Secretary, Medical nti Surgical Section. Mr. If. I,. IhiM-, to rWri-iary. Mr. Bruce Smith, Secretary and A.wi.stfuit Director, General Claims Division. Baylor Medical College........ ................ Dr. K. Stanley Crawford, .Assistant Professor of Surgery. Central of Georgia Railway Hospital. Dr. J. K. Quultlobaum. Railroad Retirement Board....................Mr. K. E. Koch, .Assistant Director of Unemployment and Sickness In surance. ii \ ... t 16 MONDAY MORNING SESSION March 24, 1958 The Thirty-Eighth Annual Meeting of the Medical and Surgical Section, Association of American Railroads, convened in the Edgewater Gulf Hotel, Edgewatcr Pork, Mississippi, at nine-thirty a.m., Chairman Ira Goldowsky, Medical Director, Central Railroad Company of New Jersey, Jersey City, New Jersey, presiding. CyxiRSiA-V Goldowskv: I will now call this Thirty-Eighth Meeting of the Medical and Surgical Section of the Association of American Railroads to order. The first item on th<- agenda is announcements, and I do have a few. I have a telegram in-re from Doctor Mack: " Cnavoidablv detained: ph-ase arrange my report lor Tm-dav in.-ii-nd o: Monday." We Jo have a letter In re mini iX;or Rnnteii. Atlantic Coast l.iiie, express ing hi- regret4 at not being wit I. u- (u-re ;.t l .dg-w .un l*;.rk fur the re.j-oti that ! he Annual Meet i;,g of tl,, A11. M n l 1 1 lie A..... l.i' mu i- held in \a-- an al t hi t urn M,i.l,i' r liuiiM |:,ni- lurii n, ,\a- -aU. The next item 1 see on the program i- Addn - >>f the ('h.-.iniiari. so He won't hold tip any longer. 1 w ill go i.head with that, but I never do know wbv ibey make the.-'1 thing- -o lug Ladies, Honored Guests. and Colleagues: 1 bid you welcome to the Thirty-Might h A mmol Meeting of tin- Medical anil Surgical Section of the Association of American Railroads. I hope by this morning you have all seated down and are comfortably situated. If (he Southland will provide nice weather, our Arrangement* Committee and Com mit tee of Difei'iion ear, a-- ure pm of an interest mg meeting. In the tir-t dralt of the- program that our good Secretary sent me, he had noted Item No. 3 a- "Remarks of the Chairman." Now, at the final printing, I see he has changed it to the "Address of the Chairman." As my address is already known to all of you, I am going to stay with the original and make this "Remarks of the Chairman." What belter remarks can J make than to give you a summary of my Truster- ship of this honored position for the past year and my hojies tor the future. I am reminded of the story of some Brown Cniversity students vis-iting Chief Justice Hughes in Washington, wiu> was a Brown alumnus. They expressed a desire to see the Government in action. He asked them did they spell it as one word or two w<ird-'.' Your Medical and Snimvai S.rlion ha tu-en "in action.'' sjvtlvd as r.vn word-. thn'igli vo.a- Chairman a- forced into "in action.'' -p,-'i-i| a> iu,( hum. .51iv (is-- month- 1 eoinmuii u tirtHorii Jef.-in C`it v i ('hir:.v wnh i".i rn i,;-v during thi- lime bv n\:ai and ph'U.i-. 1 all. -are by l.i) Frank Barker ha- iT.i-sed me the N" 1 P< si or Worn \V;,n Before this meeting, having learned that snows had left Savannah and points South. I took further rest on the We-t Coast of l-'iorida. The .-now had left, hut tin- t-ooiin-s staved. While resting, my thoughts were of this Section and this meeting. Even '`Remarks" ,-houl-t have n Rile 1 di eided <m: "Where Have We Been--Where Are We t 'n>ing'f"' 'i he \ ear- hn\ hrougiii a complete change in the thinking of the Industrial Physician wm Railroad Rb;. sieian. Vears ago. f will even say at tltt start of this lUignst sei-tiuii, li`- Railroad I'hweian wa- a "iiece--.'irv evil." Some thing had tti be done for the care of the injured railroad employe. We were r: 'if if* % f t i i } an expense to manacand Brotherhoods, injured leave changes Yearn ago we wenwith our Safety Sect dents. Not one of us injured. At* of old, w out of business. AfteT tbe last meet of all railroads who u our aims ar<-i the letter. Frank Parke sharper than Frank's hear how I wanted from the U-Uer. I at 1*,u me lo ronn-ne i mu 1 r> i nbn< r tic u V\ lull H.l- HCCiClipll-l meeting or am- futur Piocei-iimg* oi th>- in' \ out Committee during the year ami to iiimc to New Vorl to Chicago. To the cent coojienttion arid Your ('ominiii'-Stack, had lmvtmgs voted upon at this the workings and o volopmctits Resulting First Aid. Your (..`nuimUBv ha* worked hard unch sideration revised a new Kxamimttioi industry. I am sorry to hat the first time in nm Doctor Lotig'-uay happy to sa v tie iour best wishes for Your Cummin*-* Stockwell to keep in trnum.n. 1 ruler the direct, pi-i't- of Air Condi1 to dale. Tli.- Commit nv your eon*iider:ition The Committee quiescent, not l>ec.. forced into iuaction .rw .'.roods <S(ijS ii^al and Surgical Section. ;hc L'dgewater Gulf Hotel, . yiixirm.-in Ira Goldowjky, \Yw for-wy, Jersey City, ' i \ d agf.ili uf ila: \ u;i n"if K ulrnads to order, iinl i 'in !i iv<* a lew. ' arrange Monday." uiauic Coast Line, express- dor INrk for the rpx-*0n dial ..--ociation id held in Nassau - tu. : the `airman, so we won't t1S >o know whv rhev Meeting >u r fa. Medical and .Lulroads. I Lope bv tliia nfort.ibly -ituuteil. if the -uti Committee and C'om- aw-ting. ,-Vcretary sent mft, he had ' t *:;ial printing, rm in." \s my address is "a ` ii and make i u v <(',iiTru-tr-e: >r 'i.i- future. " ^ td'-lit -. \ t-l'mg Chief ;u minis. TL>-v .-^pressed i m >l:d ' !."Y -JK-Il it is il ' > mil iia' been "m : in ' n ioia-i-d into `in- I >nt:nii<<| Udui-en e :i.i< nme bv mad ami d me as ttie \n. I I'-st or !. ft .*> u'.annah and point# nda. The snow had left, . ,e*-r' i,f tins Section and l -iersded on: "Where '.inking of the industrial i-\e v at the start of -e evil." Someoiui LTiM..oye. We were Proceedings of Aftiiicai and Surgical Section 17 an expense to management and no doubt thoroughly disliked by the employes and Brotherhood,-*. Kdueation of management and the good care of the injured have changed many aifituJes. but it his been slow work. Years ago we were content to care lor the injured employe--todav working with our Safety Section and thinking with them, our aim is to prevent acci dents. Not one of us want to .-ec a 'ingle employe brought to our departments injured. As of old, we are the only prolusion looking and aiming to put itself out of bii'im-'-'. Auer the 1-i't ro'-'-'ing ii ' ireenbner. l-'iiers were 'eat to the management, of all railroads who did not have a r>-|n i-entativc present, iniormuig them of our .inn' ii,d the ......--itv of bundled per emit ati.-ndanee. H was a nice letter. I'rank I'aiker wrote it, l .mi aiiaid that my words would have been sharper than Frank's; ,vi lie knows how [ fed on the subject, ho didn't wait to heir how [ wanted the letter written, Frank said he had a good response from the letter. I am going to watt to hear the attendance figures, it is hard for me to conceive of anv railroad management reading the Proceedings of our Greenbrier meeting and the warnings that were given to the railroads aud what was accompli di<*d at ih.af un-chug, not ending a representative to this meeting or .my tuturc meeting. To me it. means that they do not rend the Proceeding.-* of the meetings, of tfn-v ull class us as a " necessary evil." Your t oeatnit'.vi: of l>ir--'i:on met i-.wi-e to consider problems that arose during tiw year md 'o prepare for nos n:<-ocing. * 'nee jh,.-v were kind i noiigh to eyiliK ro New Yolk for l meeting 1....... of t||V in.ililiifV to III iKe till* trip to Chicago. 'J o I 'olnlMI lee ol I >u i-et |.,n. ' bank you tor oile huudfed JH-f cent cooperation .-.nd all y.ur help. Your Commute** on Disability and Rehabilitation, under Chairman J. K. rftack, had meetings and are presenting recommendations for revi'ions :o be voted upon at this meeting. Much ti i- n-eu done in joint -es-ion ij pr-pare the woruing * and > -r! appmg of ; ,- I 'or..:m; u-- ,nd t:." < 'omnn1 ( on De velopments Itesubmg iroin Rhvsjral Kxamin.vions, ami *h<* Committee on Fir-t Ai l. 't Il,r ` niotl I............. I ,,,-! I - - J -'l.t ,::g I I -til 1 'h- -leal I ..!>;. |1 Jons inis `.'wked i..u-i -it,-!, r t h ittto.:o I 'r A'. .1. f..,ngew:<v ,o i.r-->-n: . -r --ir. -,ii- -ii|ei--ition a :- i; --: - t or : u!. * .,n,{ r- .-ii ui-a,, nu- ] lc. -i. il >.iu.i.r 11 ims. .-. rii a im-w ICxanunatioM form t-> taml udr.-.c a v.-tem tor fin- enure railroad industry. I am oirry t<> ii.v u> - u dip j>r. and Mrs, f.ongeway aru not auli ns for tiw* first time in im.-iiiv -.ears reprioenting the Colorado .V Southern Railroad, Doctor l.ongeway li.-umg sulfered a eoronarv attack on March 1st. [ am happy to say ho is doing nicelv. .md f am sure von all join mo in ponding him our best wishes for a sjiecdy recovery. Your Committee on Trauma iv.u met under the ilircction of Dr. B. \V. Stockweil to kovp us up to date and informed in tbe latest on treatment in trauma. Under tl.e direetinn of I>r. R. M. Graham, the Comniiitia; on \f`ilirni A.-*pects of Air Conditioning of Cars arid its problems is ready to keep you up to date. The Committee on First Aid under < `huirman i-j. C. Ol.-nn, is pros^-nting for your consideration a revision of the f'jr*t Aid NtauuaL The Committee on Medical Filina with Chairman R. S. Kieffcr is actively quiescent, not because they want to be.- but rather because they have been forced into inactioo. -j r % * t. : sVrt": 13 Your Committee on Railway Sanitation uoder the direction of Chairman R. M. Graham is ever cognizant of this important problem, and I am sure will give you the latest advice on this subject. All the proposed revisions have been sent you in time for leisurely study in that we would not have to take valuable time from our meeting in having them read here today. I hope you have all your comments ready for the discussion period before voting on the proposals. I have left the following committee last because it is an entirely new com mittee. I have always felt wnh the mass of Railroad Medical Department Statistics, experience and common problems on hand, whether we be from the East or West, North or ,South, Canada or Mexico, that much could be done to co-ordinate our common problems. Much research could be done not only on medical subjects, per se, but on joint mcdical-legui problems. After much disru'-don with our nm-t and evcr-hclpfui K>-st Carney, he took this /natter up with t In- fl dn.-jec i! group of the As.v*ei:.tion oi American Rail road.-. ami they were rno>( receptive to the idea. Tta-y appointed a committee, and I appointed ft committe" troi.i our S'-cho/i, Von wiii learn the committee members and tvhal ii:;~ iran-pin.-l e> far tyvut Vo:n tin- Chairman of our I 'omrnHUo:, Doctor W. . Mulder. "To Doctor E. C. Oi**>, t"i,i<f Surgcoii. Uiinot- fViiiral Railroad. aiil h*Commit tec, our combined I ha ok.- for his liu<- work in preparing t lie one hundred and om- details tvccep'-ary for this meeting, and helping me contact some of our guest speakers. Please aland up, Doctor OLu, and take a bow. (Applause) Tins nil tells us of'`Where HY Have iP-eu." Now, " Where Are We Going-- What of the Future?" More education of management to show them we are nnf. entirely on the "red side" of the ledger, that our c-uorts produce hundred* of thousands of dollars of saving. The rejected applicant for employment with a hernia or weak bad; is our black side of the ledger. Our periodical examination that turns up tin employe with bad vision or a bud heart, again i* our black side of the ledger. Further education of labor organizations and labor itself, that the job we are doing is for their benefit, that a healthy employe is one that has earning capacity. We arc not looking to take employer- out of service. Our job is to help keep them fit so that they can continue in service. There is do department on ant- railroad that offers r hotter liaison between management and labor than does a well-organized and proper-functioning medical department. ^ heu I rend of Aviation Medicine, testing volunteers for space travel, I know that they are preparing for future regrirdlc-s of how many years it day be .-.wav. In thi> nuclear age, are we preparing for th- nature? I i.m sure, though it may be years away, the nniroad* will ,;ili be here, de-piie ail the bad limes and voices to the contrary. Arc we preparing for the atomic locomotive? Arc we studying the new dermatitis problem of atomic fuel, or the liazarda of "loose atomic energy" after a collision? We will no doubt be transporting various typos of thermo-nuclear energy in our freight car. What arc the hazards? What are the builders of our locomotives planning for the future--speeds of two hundred miles per hour? Maybe? Are iv planning for the new hazards of speed to our engine, train crews nml passengers? Lot us prepare now. Let us not be complacent and licurc to ourselves, "It will not happen in our time." The way thing- arc happening, we all may awaken to a surprise fc< caao. Let ua get out of research on these probe Let our actions and r other to aid the induatr keep himself aloof, that in the industry, and the. That is enough for m< with me &s you have ic wish to speak; all wall c } one at a time. When nogt-upher, aououtice y I am just going to t.i today that I sec so mat n little different than htoday, new with our S-- .Voivj J i,m going t.< would like- each ot you railroad you represent. I wax Imre three days, out of here. Let's stand up. ........... Thereupon, names........... So, maybe Frank's a rc|tort following me, (Announcement!!) Those that arc here hesitant, let your hair over and shake hands other belter. (Applaud Number four, the for five months. I will I would like you to enough to have a eocrc Sectietart Pahrxr lined the years actsviu helps me cousidcrabi. ( ouv letter to manage in tbe Section, ivbcrev it the suggestions of U>t we were able to draft scnlution in the Sect new doctors to our li Of the several do< Medical Director for Chief Surgeon for t) sentation. The bah fessio&u! reyreseoUt 4 * Via limp if vo j  'invctioa hi Chairman : Icm, and I am sure will :e toe i'-/3Lir<'h- study in nifvfing (a having them *' "iy (`>r th>: usiousston a i.*;ri-1 in -.v I'-.nii D.-parum-nt iiu-thor wq he irom the t much could Ko done ''uld be done not only robk-ma. ;1 Ki-n C.irncy, be took 'nvn vi Arnorican Raii^pointed a committee, tU h -trn ihe committee r, the Chairman of our ' 'fi'iid. and his \rit. . one hundred ' - nic contact Jnm of a hgw. (Applause) > here Are SS e Going-- not entirely on the . of 'hou.-anilj of ::<`nc with i hernia or ;.c.:i ..-xaminacion that -*Jr n '< -ide of ; : ; -if. *h it ri;>* ' or.c that has ....... "f - i i|Jr *t C\ I cn. a-tf.T iiaisofi between - r-'Tcr-mnctiotiing !S :'t -price frnvef, f * of how many years ( .m sure, though it ful the bad time* and io'-omneive? Ar we 'tie iuuarda of '`loose - transporting various hat arc the tuswrds? he future--Njaed* of < for the new hazards -raelves, "It opening, we ail may Proceedings of Medical and Saripcai Seclum 19 awaken to a surprise before it becomes time for uh to retire. .v>, f plead my case. Let us get out of our rocking chairs, .-ct up the necessary committees for research on these problems, and be prepared. Let our actions and planning be uniform for the industry. Let us help each other to aid the industry .as a whole, and let do man feel or think that he c/ui keep himself aloof, that this department is the best or better than any other in the industry, and that be can co it alone. That is enough for mo. There is much work to be dm)" 'his morning. Rear with me :w you have for tin: pa.-t tilte- ri minutes. Address the Chair if you wish to speak: all will get a chance, but it will run more smoothly if we -peak one at a lime. Wlc-n you get up to -jieak, please, for the benefit of rue -tonographi-r, announce your name and the name of the railroad you represent. I urn just going to take a minute, because I am awfully, awfully happy here today that 1 see ~o many new faces, f am going to digress and do somctlung a little different than has been done before. I want all those who are new here today, new with our ejection or meeting for the first time, to raise their hand. Now, I am going to start over here. Let's start right in the front row. { would like each of you to gel up, announce your name, and the name of the railroad you represent. Let's not feel :u I did at the first meeting l attended. I was here three days, and nolxxiy knew I came in and nobody knew 1 got out of here. Let's -t md up. ...........T!ii-a'U(;n, new tm'iulx-rs to the tnwling rose -uni announced their names.......... So, maybe [Tank's letter did do some good. I know he is going to give you a report following me, and I am surf* ho will have some good things to tell you. (Announcement s) Those that arc here for the fir-t time, please don't be backward, don't be hesitant, let your hair down. If you a<.e somebody you don't know, just go over and shake hands and introduce voursrlt. Let's all g<-t know each other better. .Applause* Xum.'e-r four, tie; :a..->i -.vi.n.mr: ;i guy wr.o helped me slide l was inactive for five mouth-, [ will have ihe r.-p.,rt from our .-vcp-'afy. IT ink I. i'ark'T. I would hke you to a.,-.-t -oiin-body You know, ,ir .Secretary ,s big enough to liavt* a secretary, lint, be is out.-iJe tiding the work. Secretary Parker: 1 hank, yet iJr. (loldowsky. Our Chairman had out lined the years activities of tin; S-idioti r ithvr thoroughly in his address, which helps me considerably. One item Or. (ioldwsky mentioned, tliat concerning our letter to management requesting professional representation be appointed in the Section, wherever po.-whln, did meet with a great deal oi success. Through the suggestions of both Dr. Goldowsky and Dr. Bennett, our former Chairman, we were able to draft a letter which resulted ia increasing professional repre sentation us the ejection by Approximately tea per cent. This added tweive new doctors to our list of representatives ia the Section. Of the several doctor* who stood up a moment ago, Dr. It. A. Johnson, Medical Director for the. New York Central Railroad, and Dr. E. T. Stahl, Chief Surgeon tor tlie Mooon Railroad, replaced former professional repre sentation. The balance are all new members who have replaced non-pro fessional representative*. At this time, if you please I would like'to make a few additional announce ments. (Announcements) /V.f'. .. 20 AMociaffon of American Railroadt Please feel free to oil! upon Bob Hose or myeolf /or any assistance we may be able to render during your stay here at Edge-water Pork. Thank you. (Applause) Ck/jrjIjcn Goldovsky: Our next item was supposed to be the report of Doctor Stack. Having received his telegram, I did make a shift, and at this time I would like to introduce Doctor Hollo, Chief Surgeon, St. Louis-San Francisco Railway, who I was kind enough to send to the [rueruationn! Union of Railway Medical Officers, in Pari*. S *plcmbcr 24*30. 1037, fie does have a report to give us which was requested f>v the powers-Uv.vt-be in the Association. !) V. W. Hoi.i.f; (Chi. i Surg< Si. Loui--S.ni Ftunci'*"> Haiiw.v.-. Si Loni*. ! Mr F'hairmaN and M<mbrr.- of the Asocial ton of American Hailroad.ii At nouniiiiie on Thui.-dav, Svittetnlwr 19, 1937, my wife and 1 s.!)] from New \ ofk aboard '.t,.- }.ii,. r >S I roil'd Stan *. Alter an wilting vov.ig. aboard .-inn. we duel.od :u V H.;vr- Idaiirv, Tu'-.-div morning, .September 2Hii, and vn boii-n m, nrriv< / m IV.it- turn ab'-mnot, A i o . !>>- k. W Iu>' d .< j,,'.. 11 in. . ,i -pi i-mJcj 2.*,lh. wv I'i'.i. a t;.\i l n Centre Mareidin It* rt/ii-lnt `gS hi*., ru** Si ) ><rnnfiifjije, Ih.ns, where we both registered n,r the > vi-rub t'>,ngre** of th.- I nimi fnieni:iiii>:,Se !>.> Service* Medicaill De,- Ch.-mu,'- D. l.r. It lit rmiomarv for the wiv.-s and family of the delegatus to register a# well ns the delegate. Each perron was given a portfolio containing the program of the meeting a- well ;o> sjxeial invitations to well-planned entertainment for the delegates and their families. Doctor Ortega, llm rs-eit-iarv Cb m.-rol, wan o/i hand to extend u mud cordial welcome to u- and expr..- .-d hi* sincere thanks for having art ollieial observer from the Fluted acute* attend for the lir.*l time this year. I was then formally introduced to all the delegates from other countries who are members of the* ('ungre*>\ There were 122 phv*>t-iniir- attending ihe meet ing. The nnlv enmiiiie* in Europe who are not meml'er* are Bulgarin and Romania. Roth the Ct.ited Stall-* at,,} Hus-ia had mlv official observers attend tin* year. The Congress in general made it known to me that it was most anxious for the I'nited States to beeome a participating meinVr of the Union Interna tionale Dee Services Meduaux De* Chemins de Fer, and asked me as an official observer to carry this invitation back to the States. After meeting d.-lognl.-- and r-.veh.-.ngii.g greeting.*, the meeting was formally opened at eleven oYloek by talk by Mr. Arinand, the Pre*id'Ut of t[><- Union and Pre-id.-nl of 1 he Admini-'rnt ive <'mini II Ail i < . ' -. ub-.-r\. j *, Uk ir wives nod i. in,the* ai i.ii.l'd l l,i- ,- e,n u i j it'll w.:* h- r.l 'i>v m.-aii* <; inter- ju'eter,* and earphune.-j in nmr iangung.*. English. J'rui.-n. fiaiiaii and German. 1 he meeting wont froiri Monday ihiougu Sunday. The program was verv i/Uere.-iing and thorough. Under separate rover you will all have enclosed in brief outline form statutes of the International Union of Railway Medical Services wfiich are M-lf-expianutury. and the English translation of p.qx-rs ns given. However, i might bring special attention to the fact that the meeting-- are held in di'.Tvivnt ommn.a war. The emmiry iu wnich the meeting i.-i held pays &li the expenses lor the entvrtaiuincut of the delegates and their wives widle ai the meeting. The delegate's own country pays his transporta tion and hotel extwnse. | j J f 1 I The r: of psyci of prop'*' Howe' Europca The a: qualiue.and mail degree, ; ami :d'd' It 1..advniii-. s-lnti tm u\ o-.\u pneu." ' . empli'Vi- rnd'V' Mall > an empl for hi* a With it is mo operator UtdiiioJog Thank (Thel bv Dr. cotnme of the ( Dk. road, Surgical of the various n port TV SvcUvIl Americ Tiiv "The I Tin-' again We is pl.u HOb. before We 'i.^LJtacce we may Park. Thank you. to be the report of v duft, and at this 4'on, Si. Lotns-San trernalional Union ,7. lie does have a r in the .V-nociation. .cisco Railwav, St. elation of American uni l viilcl from n I'xriuiii; v<nriii aiming, .September . '.vp took a taxt to -.a, where we both . mali: D>-* Scrvicca tO` ' .13 well ug uu . agrum of r.'i rt.ur.nK-nt tor ad a most cordial a otlicixl observer uor countries who .riding ;ho niift.re I' ,!g ina oid .i. i ti ..i.-crvvrs .. l.Ua'W lof : Cm.ii intrnva- k-d re- m : irg u ,3 formally : m it ' :.f. L nion - .i|,.itv-'M, their :iv ms of inter* di vn ami O^rtnon. roir.un wad very nave enclosed in '_ilway Medical nation of paper* i he meetings are a t:.e meeting is gale* and their ' ins i nuisporta- Prorr*'lir>'j$ of Mviral and .'i'trqiail Section 21 The medical presentations at the Parts Congress dealt with the application of p.svrhoti'rbmcd service? m pre-mapl'iv incut ex.iinmalions lor the purpose of property rvirrutum; '!>' i*-t 'inn d individuals J<>r various jobs. However, I would like to inject a thought hero that all railroads of the European countries and foreign countries nr nation ,ilv owned. The mm of the psvchoteehijienl tesi-. i to brim; out tin; individual* -pedal qualities, both good and bad. They lie|(> to reveal Uvoleiplatc }>efsonaiil ii-H and inability to m-ordin.ite both m-ntalU and pi.' aeally. The w-ms, in ,-ome degree, are able to measure mvtnorv, react ton time, nbservition, perception, iml ability to concentrate. ft has lw-n olj'erved 'hat j>-v choo , hno)..^v -eteatilie-dly applied can be advantageous to both industry md the working man. Jt helps to deerea.se stall turnover as well as .lectilenf. are! uds hi -hoileiiini; the training period of certain individuals in p.irtieiilar oiaaipations. ft c.att definitely increase production and produce i sati-t idorv id iiam-lup Itetwren employer and employe. ft would In- most dr-arable to have the r-}x>nsibilit v of selecting employes .'harts! by mure than one department. Management anrl the medical fluff aidud by sv psychologist, and a physiologist could evaluate the abilities of ua employe ami place him in the particular tipe of employment best suited for his ability. With the increased ire* of complex iw-chani/ed equipment and efectrouies, it is most important to have a wcll-.-cli-cted, well-adapted. histhlv*n*s|>on*ible operator at all times. This can he bettor aceouiplisfn-d by the use of psychoti-chnology in pn-emplovmeiit examinations of all pi-r-onnel. Thank you. < Applause) Cft.OftMAN (Jot.UOW'KV; Thank l.ill, IJ- ' UT Hollo (There followed a brief, oiT-tl.t-reord ui-rii.-Mon oi the Report presented by Dr. Hollo.) C'UAtKWiN (ioi.iioii'Kv: t'h.iuk v>>u -.a ui l> mi'iv h i here are no further 'nmrtienis on thi* -object, we wdl go -n ' . -nir ir-vt i'.-rri a hi. ii is (he Report f die t'.Kiumuw >,n i iauina, Doctor .-Moekweil, ( h-iirman. f-'il. '.V. Si I r. . -I ;a.u 'l hi' I >m oil. i ' Moll ,:;d do .'hoi-- I 1? d- id. I1 .at. Mi. 'li'.Ma): Mr t . .. oi. \J rebel- u! i he M-died rid sur3V'll >.'!ill!I'. IT- i i.irmtiee .,u Ti .u::,a h.,.- i..nl ;.o foiai.d meeiitias -tai-r; ifre aivtitu; -I tin: S-rtiou last pritii; m Whitu .-`ulmr .-'piit.'i-. West Virginia. However, various members ,,t ll( ('onmniiie have n. )d'- -ui-'yi-iions l oneermm; ouf lepon for tins year. Tin* ('ommittif w<>ul<l hke io auaifi i'iimru-r*) lo hi: rnemhers of I he Section two hook lets which are i.-sind by ihe t oniniiHeo on Trauma of ths Aiaerican College of Surgeons: The lir?t is an "t.'utHne ui the Treatment m Fractures," and the sccomt, "The Earlv ('am of Acute Sul Tissue Injuries." This Cofimmtee h;w recommended these fiouklcts for several years, and we again would like to call them to votir attention. We have been udvi-ed that the -ubcomnnitce ou the Soft Tissue Manual is planning a. revision, ami they have held their lirst meeting on February 6, 1958. It baa been c-umated that it will be .ipproxmiati-ly a year, however, befor the revised edition will becoimi avrulahle. We are further advised that the subcommittee on the Fracture Manual ia considering a new edition, however, nothing dcLiutto has been tarted so far. 22 Aa*evwfe?n 0/ American Railroad.a These booklets are available from the American Collide of Surgeons, 40 East Erie Street, Clucago, Illinois. Booklets sell at a dollar per copy, and they are very valuable, particularly for distribution to your District Surgeons, and they are particularly valuable in teaching the surgery of trauma in your hospitals. Doctor Duncan Eve, Chief Surgeon of the Nashville, Chattanooga & 8t. Louis Railroad, suggested that this year our report should include a colorsound movie on the subject "Transportation of the Injured," which is reported to be of good general interest and which was made by Doctor George J. Curry of Flint, Michigan. The Committee takes pleasure in presenting this Elm to you at this time. (There followed the showing of the motion picture film omit led "Trans portation of the Injured.") Doctor J3. \V. .Stockwcll: I k-m that we have with us Doctor Wagner of Pittsburgh who wav mentioned it, tin- film a* one of the members of the Committ'.f mat helped prepare tie- material. Doctor Wagner, would you care io say word alxiut (In- film? Uu. .1. lit km; Waunlji (Chief Surgeon, Bessemer and l.akc Erie Railroad. Pittsburg)), Pormsj'ivjuiia): I think it speak.- fur it'i-lf. Thi.-is truly (he work of Dr. Rt,l-rt Kemiedy who has been advocating the proper transportation of the- injured for a period of twenty years or more; taken up by Dr. George Curry who really was the producer of this very fine* film. As it i. -hnwn throughout the country, I Ix-hove it. mil do much toward tho helping of thin problem. Nothing is better in the wav of education than a picture. Dr. George Curry and Dr. Robert. Kennedy and the other meinb.-re ol ihir. Co/I.lnltl*-.- HI.: Ui i.e cof.glaluiuled. Doctor B. W. Stockwell: Thank you, Doctor Wagner. Da. C. F. IIolto.v (Chief Surgeon, Central of Georgia Jlnilway, Savannah, Georgia): Doctor Wagner, what i the name of those padded, metal splints for the leg? I would like to get point of them. Do you know the name of them? Da. Wagn'er: Sorry, I can't tell you the name of them right now. Dr. Stockwell: On the Co/nmittoe on Trauma, our group, we have Doctor Duncan Eve. We would like to have him say a few words if he wiil. Dr. DrNCA.v Eve (Chief Surgeon, Nashville, Chattanooga and St. I-ouis Ib.uw.iv. .\a>hviile. Ti niii-.w-o,; 1 certainly enjoyed the film, ami it is a hard prujoition to get thi- around in every nn. t>l course, we have Ians in Ten nessee in regard to the handling of the injured with ambulance jn-ople. In 1955 I proposed to the Academy of Medicine to appoint four or six out standing young men, who were well qualified ia trauma, which we did. They visited the people connected with the various ambulance services once or twice a year and gave them very careful instructions, especially in regard to wounds, how to apply tourniquets, and, in the ense of bodv injury or neck injury, mBtrueled them fxisitively to avoid j:irk-knifiiitr the patient. I do not think that you can have a meeting like that and be successful in getting them to come to you. If you have leu or twelve ambulance services io your city, about five wili attend. This way, we thought we covered the j ; field very well the injured p< Thank you. Doctor B. Doctor C. asked a quest Dr C. F. H I think that for a shoving state poiicvru Our truublhave no tram We have ju a feiiov with told him to w 1 -.y.'.-rct i a riim.iiig !u lance people. Doctor Soi Dr Soctt Norfolk, Yin Doctor Holt patrols. Tin to know niio of tin- cas<-> some way tk Nov, in N" very much fire departnv The biggv ample, it is look at the look elscwhe; and a compr by the time Especially film should enjoyed it \ Dr B. Doctor V Misliler, w Dr. W. have nuthi Dr. Stoi Doctor This mo of the Corr Twenty morticians i*--;w. rtyy >,V'ITC -r* e of Surgeons, 40 East mt copy, they are strict Surgeons, ;md *v ot uuma in your '<, Chattanooga >fc St. i.jul'i include a. color.:vd." winch is reported >.e-tor GeorgeOurrv : (o you st this lime. film i-miilni ``Trans- i us Doctor Wagner of members oi the Com- >hc him? .d f. ike Erie Railroad, Md" truly 'he work -v.i-* 'jortation of n up Dr. George ). .. io much toward the m' education than < it her members of this rner. , i' \ 1" S v . i . . -i. .,!:< -ohata . mu- ol them/ .-.a r.gnt now. or -.'roup, ive have . i. . aom.a if tie will. ..'jiMic.t ./} 1 .St. IxjUld ni;u, ami it ia a hard a iiave laws in Teadl.llK e (K-Ople. point four or six outa iiieli we aid. They rvii'i's >nc of twice tfi ngard to wounds, v nr tierk injury, in- uij be iieoc.'stul iu ' a -c services igtn. vered the Proceedinos of Medical anti Snnjirai Stclion 23 field very well. It is remarkable how much they have accomplished in bringing the injured people to our ho.ipif.il. Thank you. Doctor B. W. Stock^t.ll: Thank you, Doctor. Doctor C. F. Holton, a member ot our Committee on Trauma, has already asked a question. Do you have any other comments, Doctor Holton? Dr. C. F. Holton: Vo#, I have. I think tli.it is a splendid him. I have already made a note to have that film fur a showing in .Savannah at which f would like to have all county policemen, state policeman and ambulance drivers soft it. It is self-evident to them. Our trouble down there is -n many times people who handle our ambulances have no training whatever. We have just recently started a new ambulance service there. They brought a fellow with a coronary to the hospital, and took him off the stretcher :md told liitn to walk to the elevator; that kind of tiling. I appreciate seeing that film, and I atn going to try and arrange to get it for a showing to the Uy people of Savannah, especially the police and ambu lance people. Doctor Southgate Leigh, Jr., vtll you say a word, please? Dr. Socthoate l.Brnrf, Jr. (Chief Surgeon, Seaboard Air Line Railroad. Norfolk, Virginia): Ci-nti.-n-.en, l think vo> ought to -tress even more what Doctor Holton said about ihe potiw departments, and especially the highway patrols. They arc #up[>o.-vd to have had hint Aid training. They are supposed to know about it, yet I have found in Norfolk, at least, in a large percentage of the cases they bring in, they are doing some damage. There ought to be ?orae way that we can get over to th.vn. Now, in Norfolk proper wc have an ambulance service with trained crews, very much like the ones -bown here in Flint. We have, also, the volunteer tire departments. They are well trained. The hugest irnuid- inn.-.iontly n t.-*? one injury hut multiple. As .n cX- .myle. ,l is die m.iu h.i* the -calp torn up and a broken back, -oo. They ' .ok at the one that is bl-a-iing and causing the trouble, arid they forget to look elsewhere. We have bad, 'ime after Mine, a man with a dp wound, aid a compression fracture of the spine. They neglect the back fracture and by the time he is in the hospital he has a paralysis from Ids waist down. Especially with die police department and the highway safety patrol, this aim should be given a wry universal spread all through that group. I have "fljoyed it very much. Dr. B. W. Stockwell: Thank you, D*>ctoT Leigh. Doctor W. E. Mishier is a member of the Committee on Trauma. Doctor Mistier, will you say a word, please? Dr. V. E. Mi^hvkr iChief Surgeon, Krie Railroad, t'k-veland, Ohio): I have nothing to add. Da. Stockwell: Are there any other questions? Doctor Wagner; Pardou me for getting on my feet again. This movie. "Transportation of the Injured," has been one of the projects <rf the Committee on Trauma of the American College of Surgeoas. yean or so 8go, it was hoped that, perhaps, through contact of the morticians who handled most of the ambulance services throughout the ass* - .v-'f A'--' n A**onaiion of American Railroads country, wo could get proper legi#l;iir>;, oo that nil ambulances muxt l>c (.-quipped with projx-r splint* and other apparatus to give the proper handling. The mortician.'' were contacted and at first the move was resisted; in our district, however, with a little propaganda, they came around. In Michigan and in several cities throughout the country there has been legislation which makes it a law that ambulances must be properly equipped with trained at tendants. If any of you gentlemen are interested, write Dr. George Curry and yon will get all the literature neenesurv as to the methods of procedure to have proper training for ambulance attendants m your district*. Dr. B. W. .Stockwell: Thank you. Dn H. M. f'.nui'.M (Direct 1 >i jun r: Ml M' divine and S.'.'lll'iner Pullman ( . |I ; ...I- ' 1 ..I O e..fu, I V. .Itild n -I llr.1- 1 Jnei.l ! I 1 f hi' 1- l,<-l : . -ub.n-rr o; l)n t 10(1. Doctor Ko-i <- U`< i,!>. name aa* u n< mne i a-- mu- oi th" members - the (nimi.iUe.- for )i.;UV i ai:d .-.ViUt v,. Ill .--five \ <-ir - ;,e.. u..s U'.i tii Mjii< u:tuntil>-i mil ,-c-n <i j,, ii oildi in- in tin t-an-[iorf;;tio!i of t!;c injured He w ;- o-.< o; tie fir to a-;-. tl,< nj '} fe'phiii - ill have Th":j.-i' -ptilil- ij* III re pill- : : i II .mi'-or"1'ii" o; th r.iii'.o.el 'urged, who Y>:i fail' ') Io in-" jil.ua As mo-i nf von know. i>o< 1...... \V< til> di'-ii several months ago. Du. Ik W. Sr in'K n i.j.r.: Air. other di-ru--ion? If not, that conclude- our report Chairman GoUiowskY: Thank you very much, Doctor Stockwell and your Committee. f.\pplau-e; Our next reji'irt r- our t'oiumii ;>-e on i ir.-f \id under lie- ('haiiHian-iijp of Dr. 1.. t`. Oi.-un The i- e vi-i>>,, of l',r i ir-l Aid Manual. au<I i ttiitik wo wilt more or J,<. usk i )<H-t<>r t >1-.>j, hnr he is t hroiigh lo ha ve this presented to us to vote <m ii> adoption. Dr. E. C. Oie-os (Chief Surgeon. Illinois Central Kuilruad, Chicago, Illinois): Thank you Mr. Chairman, (h-titl.-men: Thu Committee on First Aid is very grnteiul to Ihe Committee on Trauma for the very fine presentation this mornius on its behalf. Last vent you may remember that tin- Committer yn Disability mid Re habilitation wished to have certain items transferred to the Manual on First Aid. In doing so, wo took ort-adon to go through the whole pamphlet and make what re dly an,mint-to mu.or e.nv r tio:,- h> r>- and liiefe. Some of '.hem uere nothing more than Lruru.-.ge structures J doubt th.,l if i- important that uv go through the wide twiMi-d. n.-r'-lv ji-iirit out tii- civ.am- vd.u ri liaVe hevn lilad' . \ <>u probably luce u copy of the revi-iom. and l will mereh r- .ad t he points where we made change- ami make af.v comments that seem pi rtnx-nl. On {rage 2, it says: "With fin--nre over wound to control bleeding if necessary," Then w* skip over to page 7 which is under the* subject of Electric Shock, and read: "Institute artificial n-.-mraiion immediately if the victim is not breathing and continue iiruiiei-d r---jjir.-im-rr by the back pres-are arm bn method, a- long indicated, or untrl unmr-tnh.-.bie signs of death.'' " Victims of eh ririeul accident in the vieinnir- of large cities mav receive rapid emergency treatment by the inhnlator squad maintained by most police department-" Sow, uuder th made eonv' ol*"- j would like t' ftre one hundivd regarding cart**' has changed c"" small quamitv o with g.ss eng"- It has been n odea of nitrxt' with subsequeui Aldehydes ;'" extrrmcl v u 1" individual << 11 lihdy that eol'Cv ut r.A e-e ' It has U-en ). requin >t to : ` shut li'O'.o > Mow, on thai -oggvst that e monoxide i- curs where elm gasoline enp*` diesel engine ' jneride-d that of exhaust gn-> Further <i"> oxygen and cm one httf been On page 8. passages will b the head of D' Voder "C' .saved and m<> ho^pitti-l or hr accidesit, ossui And, unde error and )*' On {lace 1 of the originarm and leg luwer extrcinii the arm does in order to lw a single one question in n Kituulion. Now, oo portaut thing extent of the injury should ..'v/rr*vla .1 imVmlacc,.<must'>'''-'T'ii|>|wl :>.< proper handling. :ie move was resisted; m nur v around. In Michigan r<* tua b<cn legislation which -rvy > quipped with trained at- \riTc 1 >r. Gcorgo furry the ir.et'r.vds oi procedure to n ymjr ib-'ricN. >t M--li. ill ,v<"i record. l would just like to tujii. >firvi ,i,-i oite of the members of uv-five years ago was m the !r:ui.i|)onation of the injured, uemoa .splints or have TUhmmus of the railroad -urgeon who non d months ago. .,u*-h, Doctor Stockwell .-uni i .r.-i'T the k hairnvuiship ,,t Aid Manual, and f 'kink <* .rough :<> have this prr'.tiiiM [ ' bic'.go. ! r'iuot-o; i 11.<* i ' W'.- 'Mi Trmmn . litre mu Di.-.tbility ami tte- ri-d '> ri'.-* Manual on { ih the wiinio pamphlet. md re i'ii> there, .fume of them : doubt that it is important M.nt out the changes which I f aiH merely read 'he (minis , 'hat M-em (xirtincnt. imd t`> control bleeding if .< -niifct oi Ebclric -Shock, viiatclv if the victim is not tie; hack pressure arm hit ii; of death." " \ i' tini* a.i /e rapid emergency mom , .ee depart Pmcerdivii* uf Medical and Surgical Section 25 N;t. under the -uoject of gas poisoning, Doctor Gufdowsky very proper! v .v-me Mb'cn-uions mout the original comments. I W'-vxkI like to say, -ince the .advent of the diesel engine, many railroads ire c*e hundred per cent d;ea;lized, and others greatly so, so that the picture recscarbon monu'Cide :u a factor m gas poisoning from motive power has tinged considerably. it develops that the diesel engine produces a very "iiititv of carbon tr.vno'tide during combustion of the fuel as compared a-.ti aguu-s >)r .-icam '.o,:, .motives. !: n found by 'iiat carbon monoxide is a negligible factor. The : .'ij'rMgvu arc a much greater factor in producing general irritation vttA t.'.---Tuent broiichi'! old pneumonia. . ;<< d-(> pr-clii. ,-d during tie- rninbu'lioti proces-cs, mid iheai> art* extrvse-iy irri* itmg r<j .........yes, nasal and pharyngeal mucosae and warn the imiivjrgAi mi the presence of these gases very quickly. Therefore, it is not likefy ~zai one would volumarily remain in the presence of any appreciable coQCtcTVJon > the.u* fiKs.es ior a long enough time to do any harm. It LiS '.wen suggested by nve'tigatois in this field that when: a diesel engine U rcqrar*r3 to stand for longer than fifteen minute* in a tu/me] that the motor 1* shut ion n in oriicr io pr'-n ui undue aceitmtdatiuii <j( cAliaUst. gases. \`or that basis, and you do not have this in your copy, I would like to suggest 't-it w>* r*'vi>c 1'i-ni No. '2 under tins I'oi.-aiiiing to read: "C'arlion rnoooii.>- .* i < *>rirss. odur:-?s gas which may be found in he:,teJ i i'frigcrafiir cars barcoii f/iirncr^ >rc used, and in garages or oilier pi ices where raso'iir.< " guc- ir.iu-t ;'n:. s ,v an-uu.'ilatc. In r.-uimad iii'iii- Is aher-- a diesel -r_~- j. e-ijiied '< ..nd ior more Ilian fiftivn minuies, ii is recom- menueu -_ii r/.c motor i.e -..ut down in order to prevent undue accumulation of fcxftnUfc*" 2?** ' That is 'he "(id of the < ti:uige. Funi-r >mwo a the -->t M*at -ame r>i!>jei;t, -.ve read: "if oxvg'm or "'tygt'Q ~. ; earb'.n-'tioxid** *..:x'ures lifts available, they may be Used in case one h:w --"j trai.'.-d in i:- ' On patf*^ <j. ?h:s <s jus' , < r| h:r:g|-: " nr-dn-igo of . inr ri-.m ties air vs 'g-s . : e.<areui.oi'.n in jinea-d." Th l c.:;n-'- und'-r 1 tt'i-'f gc "i, A..- ,r .gr";*b r'b.,1 -ubj' i-, 'T :ie AI.'I tc- "'I c.r _ > e J <c.i ,o.`<| ii injured is prorepilv t. fnovial io '1 -pual - ,;;j -taimri -/ ad oi waiting for a doctor to arrive at scene of swidem. u-ezriirg 'hat rcrr.-.-i) \* j-mper :nd possibh?." _-r 'll " /f Frol'..';- irtm Heat- of Cold. That is a typographical rrfr HflU -gj.iuid left as ir. w a m the original. .2. there is another :*wn I have here, on the splints. On page 10 ?:rt aid manu.u. 'here is a pre'ure of an individual who had an VT|' ftnd .."r -pjint applied, and it reads: "Hoard splints applied to arm and k*fT Nttftsvjty for fractures aX>vc live. Uiu-v.." [t ii obvious, of course, that does i*ot enwr into tin: *uiation in a fracture of the knee. We thought *,'*der to j* *T:pii<rit. it would to separate those pictures and make **0gle 009 -j;r ihe arm and .u^/ther one for the leg. Then there would i*e no ift 'ar unod of .uiv tirvT-^a<l individual who happened to run into such will tiavc them .Tt<`d, if vou so agree, at those points. *'kw, oo -mr+ 12. rmtJcr If.-m lnjurw, "After s blow on the head, an im- thiQ^ iletimnine is tu,t only whether the skull is fractured, but tbs "+ the mjary, if any, to tue brain or its vessels. Patients with a head sbonrt tut be wjbjccVeii v> any mmccessAry movements and should be T-^rr-, f i 20 Atxortahon of Ammcan Railrocuit sent to the doctor an nkw ha fxcinible. Injuries lo tho nock should bo similarly regarded. '* On page 13, under No. f., Shock: "Lay on back, head low, loosen clothing about oeck, chest and abdomen. Transport in lying position to the hospital or doctor's office." On page 15. under Tetanus: "Wounds which have been grossly contaminated by street dirt or other similar t'orm of materials may require the use of anti* tetanus serum. Puncture wounds made by sharp objects or stepping on nails may carry infection under the skin. Injuries of this kind may result in tetanus (lock-jawj, ^ud should lx; sent to the doctor at once for treatment." I-'urther, under Snake Rite, the last sentence of the first paragraph: "Let the blood run freely from the cut, at the same lime dislodging any of the poison licit remain- by nibbing the wound with a piece oi gauze or by squeezing out a- itjlicit bh"io as jK)--iPle. Su'-iiiin to' cup, if av:tiin!>!, mac b<- applied over the wound I wen tv mmul':.* out of each hour. The patient should uol be per mitted to walk or exert him-.-if in any way. Medical attention is import ant ami >hou! i be- .. un-d a- qua !.h a- (o.-- ibt" in order that anti-venom scrum or other MipportaliVr im a-urrs mav he given promptly. Ihnpluve* working in Minki--inn-md -*nri r . ma \ l.a v- a vml.it-tv snake vi-noni annio.vin in ;>od'-rmic eontaim-r* to L -! a- an enievy-m'v mur*ure after l,,-ing bitu-n. Alcoholic beverage* arc harmful in snake bites." Under dog bite-. "In ex-e tlie dog has been killed, secure the head and pack it in ice anti send to the m-are-l Health Department laboratory for examination to determine d the dog luu mad and an to tlie necessity of giving Pasteur treatment." Those are the revisions which Doctor Iloilo and I offer for your consideration. ChaJbmaN Coi-ifOwsKt: Thatik you very much, Doctor Olson. I know the Committee bias worked hard. (There followed an otT-thr-record discussion of the proposed revisions to the report of the Committee on First Aid. A motion was made, seconded and carried that this report be reform! back to the Committee of Direction for approval.) Chairman (Joi.dow.sky: Now we are going on to a very, very important committee and a committee that has imm- a lot of work, the Committee on Developments Resulting from Physical examination*. As I told you in my little talk, Doctor Longeway is confined to the hospital. Doctor Jensen, one of the members of this committee, has kindly consented to take over Lis parr cf the program. i Du. J. M. L. JrxsF.s (Oi.it) Surgeon, t.'hi>-ago. Rock 1-d.uid A- i'.o i/ir puil- road, Chicago, Mr. l'!iairri..,n: Doctor LotJgcway called a mmine of thi* commiti'-c on November II, 1937, for the purpo-e of revc-mg thi.-, circular. I don't think I will read uil the change*. However, I will call your attention to each one, the first hemg page li, ii<-m No, 7. I would appreciate your reading this iu-ni and making suggestion* and recommendations. Chairman t roLEOwsKr: i think all i!j- members have received this about two or three weeks ago. it was given to you in time to eit down aud look thi* P over and bring an> or corrections. I think we will p anyone who has an I have one recon that if anybody eLnow. Dr- J. M. L. Jen tive to the form i ``Extremities" aou ``amputations" ar.o the subheading "0; CilAlRSIA-N Cou. Dn. R. J. Ben Chicago, Illinois): should bo done nl t numerator in thr--tu use f<Hin*Ti in<: ill or in here? Woe Then, I do lie-lie some channel* the hearing, I just wo available. Dr. J. M. L. Jl glasses--it i? suggf which the exanum-t of hearing for ordio I do not quite color sense. Are there any ot. from the floor' Let's start in the Dji. K. E. Dow Montreal, Quebec course, for employ thing about druc? in the (irsl-aid kit4 Another thing, because we feel it site of injury ami do not carry U>urr perience*. Wt ran as a tourniquet, bu These are not sw suggestions tiiat a practice. The reference tl me to be a first aid  ok houid be similarly ><i lw, loosen clothing "icion to the hospital a '.To.'.'fv contaminated (uire she use of antiis or stepping oti noils : :n.ty result in tetanus ; f re itmcnt." .irst ! ir.ojr :plt; " hut ;'i*.* [I'li-'/fi :.:u or by -<pi<.u5iiig <>i|t ;u a' !-< ipphi'.l 'W :iV -ii>>uld not bn p:f.stcotixit ii important >.it anti-vcnnm wrum Employes working >m antitoxin in hcp<>- u'tof lumg bittcu. ore the head ami pack lie ' ir examination i.-iif P;u~!CUC r your consideration. v.or Olson. I know reposed wi-ions to 3 made, -' cuii'led aad atee <.i` direction for t .r if! _l n t , iiiiiu! s' "s* ..:i> -1 o hospital. _> sin.liy consented ; uni St Roane ilail oil .N'oVi-mber 1 1, - .;! \ cir attention :.g 'o.'gi'stioiis uid motived this about t down and look thia proceedings of Mniical and Surmcal Section. 27 over and brim? any mental notes or written notes about them or comraenta or corrections. I think we will probably let you hold the chair for a few minuted and call on anyone who had stay comments or additions. I have one recommendation that 1 did send in on the form itself. I think that if anybody else has any comments or recommendations, let's hear them now. Dit J. M. I-. Jensen: Doctor f'.oldowiky made one recommendation rela tive to the form for the Medical Examiner's Report. Under the heading "Extremities" and -ublieadiug '`Spine'' it ww -niggiMed that the word* `'amptitiuioni" Hid icmri'd" do d'-luu-d. 1 would further suggest that the subheading ".Spine" be placed farther to the left as a heading os its own. fiunu/AN (Joi.nowsKr: Doctor Rcntutt. Da. R. J. Bennett (Chief Surgeon, Elgin. Joliet & Ivistem Railway, Chicago, Illinois): Mr. Chairman: Under vision, in otir honk it -t.itus it should Ik* done at twenty feet. Would it bo of any value to put twenty as & numerator in thce '`withoui glasses,'* " .vith gkiasca," nod then are we going to use fourteen inches for she reading? Should we put fourteen as the numer ator in here? Would it help any? Then, I do believe that probably under color vision that even though in some channels the lantern is frowned upon, it is not universal; and also under hearing, I just wonder how many are using the new modern apparatuses available. Dr. J. M. L. Jensen: lu reference to distant vision with ami without glasses--it is suggested that a numerator of twenty (the distance in feet at which the examinee is placed) he used. The same would apply to examination of hearing for ordinary conversation. f do not rjuite understand the recommendation you made in regard to color Are them any other corrections, mr-anmendariori.-. :dditinrt.< or subtractions '.-mi : il.-or? l.'-r, . -run m ; bo front. /doctor Do<vd. D:c. k. E. Down (.Chief Medical thheer, Canadian National Railways, Montreal, Quebec, Canada): Mr. Chairman, this limt-aid instruction is, of .-ourv<>. for employes only. I wonder -ai:*-riiT it is of value to mention any thing about drugs in the first-aid text. Normally, we* do not include any drugs in the fir-t-aid kits which we u.soon our nilway in Canada. Another thing, we do not now teach the pressure jxiint method in first aid bis'sure we feel it is much belter to appw a pressure bandage locally at the dte of injury and get the patient to the doctor as soon as possible. Also, we do not carry tournnpJoW in our kite any mon* because of some bad paet ex periences. We can use a triangular bandage or handkerchief or something else u a tonrmijiitd, but i he oilicinl "t.ourui<(it<:ts'' Imvu been discontinued. '1 hi-sc not not s.-noiis enunges, but l just mention them because many of the suggestions that are made here certainly would not apply to our Canadian practice. The reference that wm made to the "mad dog situation" doesn't seem to me to be a hnt aid matter, i refer to the part which reads "la case the dog ha& V. HrXiitiI' v'- l i i >'" - *','*;.rr ~-'-V`A'iT.v-; r*-.- '' ' -'V " L**a >-v^v-5* -SKS >_* 28 Ai-ioci/ifi/m <>/ ilmencim Hoitroads been killed, etc." I question whether thin advice is going to be dealt with by first-aid people. However, it may probably be a good thing to have it included in the first-aid regulations. Da. I. Goldowbkt: I think we have to analyze it. I accept Dr. Dowd's recommendations, and it is something for all of you to decide whether we should delete or not. I think there was enough discussion at numerous times during the years whether wu should in our first aid kit have any mercuro- chrome. I think mo*--! in discus-ion would rather have it out. It was ps\fhn- lotrif.'ll. 1; Ml' t the roll.r "I the met I (ill'll tlitit dill anv good. If.ilher than huve the Itt >1 old sunn t'>>h >1 t he j i:,i ii :.| up, w i- w nuld leu vi it oul. As n fcuill. in inv mt n kiM. on our mi n railroad we have h-fl mil nil auti-'.ptn- | woo/'l fil t fier f..l Ve t fn -lll -- ini I t|P ill-- ! ll V. U h -* >1 lit- >1 l-nb- ga 1 J*e O VI T .'I U olllM and lc u- handle it rather limmnve it.mi di-eomb- th<' wound. A n v nl h<r'-'.' ) )r. KieiTer. 1 a in i rv me t<i g<> <l<e.M! in order ln> 1;. .* Kn i i i e. < hi- ; MU'. .. Mi- "'irnKiins.i.'- f'c-Mi- Railroad, Si Louis. Mi.'-onrii: Jum nrn-flv, |iu- 7, Seeiion M, under (las I'm-oniug. tinla.-t hue of tic< iif.-l paragraph. wln-re you u-<- the word ``gasoline engine ex haust." 1 would like to suggest that that hr changed to read: "internal combustion engine exhaust." Tin- diesel, producing relatively smaller amount.-' of carbon dioxide in its combustion of furl, is a hazard, but. rherr arc some gas turbine locomotives operating. i thinl. for that n-a-on internal combustion'' would cover the whole field. Dr. 1. Goi.notv.-KV: Dr. Olson, would you care to answer. Dn. F.. C. Olson: We were thinking chiefly of the small hand cars or small engines that might- be used within a building. I don't believe they have any diesel type of units that are .-mail or portable. I thought that we had covered pretty uell the item under die.-el fuel exhaii-d- that the quality of those fumes were <> irritating ttuu one could not lung remain in its presence. It is a distinct warning us contrasted to the exhaust of gasoline engines. I just wonder whether the term internal combustion would not again bring the diesel into focus as an n.t-nal combustion engine, too, and confuse the {viint. Bm. I would have no vriou- o;<jittiou or comment to make otln-r than what I have said. Dlt. It. J?. KlM-Fl.it: Thai 1' all rigiu wnh me. | -u-ln i appreciate the tact that i ou were dealing with tin -e final!', r units. You do have the little diesel units for the air conditioning in sonic pullmans and dining cars, which will be contained in a building from time to time. But. the fact that their products ure irritating will offer some automatic safeguard. Dr. I. Goujowhet: Dr. Wagner, i In iii-ve vou had your baud up. Dr. Wagner: I'nih-r the same f>.r.-iirr:i{fi. the w ord in regard to the Rent-r ation of carbon monoxide for charcn.d burners are u-a-d. the construction in the sentence. I believe, should b<- changed to read "mav he," instead of the term "might be." "May be" is permission ami "might Ik'" is possibility. Thcju/rm "may he-," I believe, coimoies that it was, whereas "might be" suggest'' the question of whether it does. For protection, I believe it would be a good tiling misused every da Now, I am not Dr. I. Goldow Du. K. C. Oi agree with you u. used in ;hi- nian no af.yciuui i<> : III! I. < .Ol.l'l'W 1 n \\ K.ii i lb- 1. ( Oi.-< Mw* nl lov'id* /n Dlt. Wuikt; D. K. V. Ou-u is previous toxin octnr i> anextrrn The point vou ujng to >it for .imt of the safety ;ailroads' Journal Experiments won .tese trains had bev ith them, and lstance did they ancc titrations of While you do iven to underslam nd would always Dr- Wight: Dr. K. C\ Oi. that you would period of timeundcr those circum Dr. Wight: Dr. VYaoner: Dr. Wight: Dr. Wagner Dn. Wight: Dn. I. Gouo Da. Wight: <ts ..jinK to be dealt with by ; luntj to have it included f accept Ur. Dowd's . i tv decide whether we .-ion at numerous limes i kit have anv mofeufo it out. It was |>->) i hot .1 ijv g.-id. Hatber lb.au : !c ivi- ......... \ i a re-nit, l most ill .Hill ef/tlCS. J r.e- gHi'i- <. r a wound wound. .a viru-r ..:usai**Tc\as Railroad, St. ;mk-r <a-i I'okomng, the word "gasoline engine ex* -id' "bitc-rnul combustion s of in dioxide iu its g is t .:!.s::e locomotives . i?ti'Ki" woiiid cover the :o answer. >01511 hand cars or small oa'c believe they have any lU^iil that we had covered : hit v of rho-'e fumes i u; - pr.... (ice. It is a : ui io;.d noi .\cnii bring .i;.'-. n.o. ia-1 c-ouiu' the u::;a tit to make other than . ii'ln't appreciate the fact iitionsng in some pullmans . ..g from tune to time. Hut, : .Mime automatic safeguard. . nad your hand up. w ord in regard to the gener* u.n'ii, the construction in id "mav be," instead of tho . i "might lie" is possibility, .t 'hercaa "might be" rm I txdieve it would I'mci'oiviqi nj \[client and tiunrical Section 20 be a good thing to change the word "might be." It is a terminology that is misused every day by every broadcaster that you hear. Xow, I am not necessarily a puri.-t, but I offer that for your consideration. Dr. I. Goldowsky: Dr. Olson. Dr. It. C. Ul.-.on: bhouid wc engage in a somuotic duel this morning/ l agree with you that the word is misused a great deal but it seemed lo me that used in this maui.-r it would be *yrimvnnms. Hut, ciTtainly there would b,: no objection to making the change that you wanted. Du. I. < I'li.imwsky: Any others/ Dr. Wight: (Off the Record.; Dr. E. C. Ol-sos: I think that the point in <iuestioo there was the previous use of toxoids in the individual which might not require any reinforcements. Dr. Wight: (Oil the Record.) Du. K. <'. Oi.so.n: I think it would dejiend on how long an interval he had his previous toxin. I think the comment there about being transported to the doctor is an extremely good one. We should change that. The point you bring up about stopping the engine in a tunnel where it is going to sit for a period greater than ufteen minutes has been arrived it bv some of the safety workers. I .-aw an item in the Association of American Railroads' Journal in which this recommendation was made. Experiments were conducted on our tines, and I know on some others, where these trains had been pulled through a tunnel. They had some rapid analyzers with them, and were able to make various determinations on the spot. In no instance did they find cither in the cab or in the atmosphere any deleterious concentrations of gases. While you do not detect the ndor of the oxides of nitrogen readily, I am riven to under-land th.it f he .d h h;. do-* ore a part of the pfo--a of ''..'nbu-noti. ,.nd would always ac t die '.\armiig -igiial. Dr. Wight: < >iT -in- (i>><,r<t.. Dr. E. C. Ulson: There is no difference made, or no recognition is given thut you would oniv ini pu.-.-ing di.-ough that tunnel within a relatively -hort period of ime. Thirty-seven parts per million would be a negligible quantity under those circumstances. Dr. Wight: (Off the Record.) Da. Wagner: How long does it take to make that trip/ Dr. Wight: (Off the Record.) Dr. Wagner: How long arc thev subject to thorn* fumes? Da. Wioht: (Oir the Record.) . Dr. I. Gogdowskt: It has not been, but we can delete it later. Di Wioht: (Off the Record.) *> vk?' .. ril -- -- 'j J - --' '' ;VjWr*i iti r! it i:i i rm< Tmu ifrirrniifitiiglffij f-i' Mi* 'vJO.-? K 30 Association of American Railroad* Pa. R. M. Grarau. Some of you people will recall the A.A.It. had a special committee here on gases about five years ago, and then we had an excellent dissertation on this by the Southern-Pacific expert two years ago out in San Francisco bringing us up to date. We are getting information here that individual railroads have done some good work on this, but work directed to certain special problems. The Committee of Direction knows that one of the larger railroads has become interested in this subject from & theoretical possibility of claims and is expected in the next few years to do some concentrated work, on it. I think the wording that wa oven by the Commi; i<-h on Fir.-t Aid D proper, and that these otte r- art- mn<i< ni:d. 1 am uonb'-nug if it wouldn't he quite worthwhile for the .S.-ctmi, to have a eon.nmtec on tin* problem alone on the question of noxious t.'oo in operating. Then 1 would lilu to requiM that 1 >r. (ll'un read that- on.- >i;ggc>tinn ngoin. I think it i okay a4 skimi-. in., 1, f h>i.;iw-. i: In \ -t i > i 111. i ,i n It.iiu, it von remember, nt uur Om.iiiittci' of Dir- ef.uit n> vine w,. reviewed this problem of the noxious gases, et cetera, with Dr, Mrshk r's M"lir:iM,"g:d J',w".'irrh Committee. They were to take it up and probahi. throw it buck at u-. whether \ve take it up aside from the m"diral-5egai problem, that we take it up with the committee per *: as a medical problem. Id other words, we are faced with two factors here. We are faced with the straight medical research problem on gases whether concentration aud the effects and relation-t ip. and we are also affected by the me lical-logni aspect-8 of this thing which ate ruining to the fore more and more each day. Du. It. M. G/uimm: The point that conn-.' up, of course, is this: Dr. Wight bring* out the point that the maximum allow able concentration of nitrogen oxide gases according to the American .Standards is five part.- per million. Jlut, that is five parts per million eight hour? {>er day, six days a week. That is an entirely different proposition. Dr. I. Gou>otvsr\: Any other comments or discussion? Dr. Olson, I will let you answer this, and then we will call for more or less a vote on these corrections and additions. Da. E. C. Olson: Should I re-rv-id that? Dr. 1. Gm-Dows-gy. W-. 1 think von bad hi m r. Du. J.. <Oi.-iiN: "(':ir(i<ui monoxide is n ri.li'rl.-.--, odorD-- gas which might be found in cither tefng'T.ster c.'ir* or where charm'd barriers nrc usixl, in garages or otiicr pber* where ga-oline engine exhaust fumes may accumu late." The alternate was: "internal combustion engine exhaust fumes." "Iu railroad tunnels where a dic>el engine is required to stand for more than fifteen minutes, it is reeomnictuied that the motor be shut down in order to prevent undue accumulation of exhaust gas--.'' Doctor raised the question about th<- u.-e of drug*. On png<- J of tie- original, the use of drugs hv first aid workers is interdicted. Dr. K. Ii- I)ywp: There are no drugs contained in our first uid kits as far as we arc concerned, Mr. Chairman. Therefore, it is sort of an unnecessary statement. !-.' * f | ; ; i ; - j ^ i i ! i 1 On the bottom of page 2 all the way through that tb aid kits should have drug? use what you haven't got. Dr. Olson: Well, I tt zephiran- That is all. Da. K. E. Dowd: That Dr. Olson: You ra:-.\. has bevu considerable ivrcl in recent ycurs, sod many tourniquet under certain ( un undue length of time, 1 1 don't know how on" c. caution m there to Ray that Dr. K. E. Down: Mr. word-- "pressure bandage'' too, to get away from tfus n. practice, as I previously sta Dr. E, C. Ol&on: I thi; been offered about it. Doctor, do you want to i Dr. I. GotnowssT: \\ which l am sure Dr. Olson v. I just ask your pleasure i. dissemination to other men. Dr. Nelson. Da. H. Nelson: (Off ti. Dr. E. C. Olson : I thin: Dr. Sbopucr. Dp. Shotntr: In regard medical student.- sometime* point, if pos-ihiv. Then, if That is the general teach World War II. That may ik Dr. i. Coioonsxr: I d students, but 1 think will: poiuts- Then tourniquets a strictive bandage leaves n i whatever means ucd or coxa Dr. Knowles. Dn. J. R. Knowles {Cl.. Massachusetts); It says __ a special _: an excellent ato uut n San . " done some - railroads ha* >: claim* and . Aid i< proper, .. :n l he quite ... .dune on (he again. surraber, at our .s noxious gases. They were it up aside mm"' e per se . the ration and the aspects ::-is: Dr. Wight .. .a of nitrogen million. But, That is an re 'it i<vs a --s gas which -mers are used, * may accumu* . fumes." "In .re tuan fifteen .set to prevent the original, . aid kita &a far _.a 'cceaaary Proceedings of StMiml and Surreal Section 31 On the bottom of page 2 you also state: "Do not use drugs.1' It is stressed all the way through that they are not to use drugs. I don't think that any first aid kits should have drugs to use. That is my point. Therefore, you can't use what you haven't got. Db. Olson: Well, I think most of them just have some merthiolate or zephiran. That is all. D. fv. E. Dowd: That is under antiseptics, I suppose; not a serious point. Db. Oumjn: Vou raid'd the quc-iion of tmjrmqiiw*. ( suppose that tlu-re lias been ooiistdcratd*: iirst aid ii.slr'u Uoti di'^vuiiuatv-.i :>a a result of tin- war in recent years, and many people are aware of the value and the need for the tourniquet under vrtaiii i,irfumstamwM. Whether ihov would he put on for aa undue length of time, I suppose is the basts for your comment. I don't know how one could regulate that sort of thing. We might put & caution in there to say that tourniquets should not be left on indefinitely. Db. K. E. Down: Mr. Chairman: Instead of the word "tourniquet,'' the words "pressure bandage" might be better. That gives you a little leeway, too, to get away from this idea of having to put on a `u-ealled tourniquet which practice, as I previously stated, is not now followed in our teaching in Canada. Db. E. C. Olson: I think that takes care of all the comments that hav<* been ottered about it. Doctor, do you want to call for a vote on it.' Db. I. Goldowsby: You all understand some of the suggested revisions which I am sure Dr. Olson will incorporate. I just ask your pleasure now in voting on this to put into print for general dissemination to other members. Dr. Nelson. Dr. II. Nelson: d'J,f 'ho Uevord.j Dk. E. C. Olson: I dunk that is a very good uh-wrvauon. Dr. shopner. Db. Shopneb: In regard to tourniquets, wouldn't it be easier to say, teach medical students sometimes, -rop bleeding with firm pressure over the bleeding point, if possible. Then, if that does not work, use the tourniquet. That is the general teaching, I think, of the Red Cross, and has been since World War II. That may soive the problem of Dr. Dowd. pR. r. Ooluowsky: I don't know. That may be all right with medical students, but I think within two months they would forget their bletaiing points. Then tourniquets are put ou, and then forgotten about. I think con* atrictive bandage leaves room for tourniquet if it is there to be used or felt or whatever mean* tied or covered the situation. Dr. Knowles. Dn. J. R. Knowles (Chief Surgeon, Boston and .Maine Railroad, Boston, Massachusetts): It says on page 2, "control bleeding and apply a pressure .'&&&. tr, *bmtm 32 bandage." In burns, aio, a pressure bandage is often of value. Would that -wf be feasible to control bleeding and apply a pressure bandage? '%' Dr. E. C. Ol'Ox: V. Dr. I. GoLuowMcy: All right. Dr. Olson has that recommendation. If there an- no others. I will call for n raising of hands. 'if .V ' Dr. It. J. Rkxxktt: In other wortis. i understand that if we use those p5eudo-i.'Oclirnii; [iir coior pl.iiew. if d.-pernl- on which set we use. Tin ' are not accurate unir>- you use a Mclhih lamp. In other word',, if yon use a light from a yellow N.,ure'- or <(h.-r >ourr-e>, tborw cards arc not accurate. They must be used with a U> lamp. It has a certain ang-trom rating. My x-cond though! w.-i- how often ar>- the (atitern- and the skeins used? We actually, personally, ha'.- found th.it the i-ochromutie color plains are the ntost accural. - m.-ato m rnumsuc vlvlb'-r tiir men are colorblind or not, for r-i or for ur*<-u. I>K. J. M. 1., .b.v-i.x: 1 foe-, a/iylifslv ej.^<-have anv further discussion on that point? Dr. Stockwlll: (OfF the Record.) Dr. I. Goloowsky: I am going to agree with that very much. I think that should be changed that an "engineer with mvneurdio-infarction should never ic- allowed to return to w aru until some suitable, work is found for him," and not designate yard service or anything else. If you can by any stretch of the imagination find a job where he would be sitting at a desk, you could probably put him in it. Hut, I don't tike to desig nate a job in train service for a man with a coronary, although many of them probably could do it. As you say, if we say they are able to do it, we arc going to have the brother hood men push our own rules down our throats. And, we may get into trouble, if anything happens we say should be done. Dr. Hollo. (Off the Record.) Dk. J. M. L. Jux-lx: That's rorn-.-t. Db. Hollo: tOff the Record.; Du. J. M. 1,. .H.X'Kv: Will \ <,u a-id il ? i)k. Hullo: fOlT ilu* Ifi-rurJ' ]). J. M. L. Jun^kx: And then drl.ii- tin- r.-M *f it? Dr. Hollo: (Off the Record.) Dn. G. F. Cushman (Chief rmrg.-ou, WeMerii I'acihc Railroad, Sun 1'rancisco, Cuiifornii): Would you consider clertro-rurdiocraph changes as being residual? Dr. Hollo: (Off the Record.) Dr. Wkuit: (Off tie- Record.) 1 i Da. J. M. L. J lacterns for testi maDy of the railr gary equipment lanterns, some us man? Dr. I. Gou>o' individually whv road by buying t. that tlsry us-.vi i; With the new slates, he i? just .ime employe U uotherbood act.-' amern sod skein ut old employe, t no trouble. I ana going bxc roronary occlusion factory evidence going to run into by your EKG w coronary person changes. Let's occlusion. Leave to feci that he maybe he will p job as a clerk so... I think, though a problem becaua figure this out, residual damages I think I would I would say: " recovery," and Dk. J. M. U Medical Lxanm on right band si Du. I. Goldo where one of ou examination for signed his name figure out what side, "Describe help us later ou personally to be Dr. C. F. Hoi Da. I. Goldowj alue. Would that .mmendaiion. il if V 11 '< Uu-.'C s.-n.-u. Thov are if . on u -c a light i, ,i'V irate. They -.in niinic. ,-ktin.s u-t-il? ;uc color plates are ,v colorblind or not, urthcr discussion on h. I think .*rcUwn -Imuld r* is i--iiiid f`>r him," > where be would be . i don't like to dosig' hough many of them g '.0 have ihc brother- . r- g " trouble, Railroad, San Fran* 4mph ciiauges as being Proceedings of Medicnl and Surgical Section 33 Dr. J. M. L. Jcn.^en: I should like to make a comment about the use of lanterns for testing color perception. I believe it would be very difficult on many of the railroads to insist upon your local examiners procuring the neces sary equipment for a different tyj of color scn.se examination. Some use lanterns, some use plates and some skeins. What is your opinion, Mr. Chair man? Dft. I. Goi.oowsky: I think that is a problem the railroads have to face individually where they have nui'idc-iim: doc tors. I -nived that on my rail road by buying these i.-ioehromatic piati-s and sending it to them. I made sure that they u.-od it. With the new applicant ccming into -crvice, if be fads on the isochromalie plates, he ia just out for that type of service. We have come across the old- time employe lint K<k''d odor voiort or profsT color perception. With brotherhood agreement, we -at down; and they are given the benefit of the lantern and skein test, but they have to pass both of them. If they fail, that's an old employe, then we try and put him in a position where there would be no trouble. I am going back to this liae oq this coronary. I think an employe with coronary occlusion should be removed from service until he presents satis factory evidence of recovery. I.eave the residual tiamage out, because you are going to run into difficulty. You are going to take those standardized recovery by your KKG which isn't proper. There are other factor* m coronary. The coronary persoa may have some hypertension, lie may have eye ground changes. Let's take the h<*ly re* a whole and not just stick to the coronary occlusion. Leave it rather broad for the Chief Medical Officer of the railroads to feel that he puu everything together, it the man h;ia sufficient recovery, maybe he will put that man back in yard service. Maybe he will give him a job as a clerk somewhere. I think, though, even leaving the word "residual damage" in leaves us with a problem became 1 dare say it you take fifteen internists and have them all figure this out, rach one is going to give you a different opinion on what residual damages are iu coronary attack. I think I would just go a iitdo further and leave that "rcidual damage" out. I would r-ay: Remove from ^rvirv until he presents -,iti.-faetory evidence of ccov-tv," and fi-ave d;nt to the < M-lic.al Kaamir.er <>f he railroad to li-P-rmine to ini liking or x> bn -at i.u union i hat the man is recovered enough '.o put nim back in some ^ervii e. Dh. J. M. L. JfctssfcN: Dr. Goldow-ky further recommended that ou the Medical Examiner's Report Form there bo printed in heavy black lettering on right hand suit* " D*-ionbe fully on back oi form any abnormal findings." Db. i. Goldowsst: I recommended that, I think, from Dr. Eekbcrt'a talk where one of our medical examiners, of course, this is more or less a check-off examination form, and he chocked oil spine or something deformed. He signed bis name to it; and it fmaily reaches your desk, and you are trying to figure out what the deformity is. I think if we put in black, bold print on the Me, "Describe on the back of the form,"which is blank, any abnormality will help us later on, probably in court or otherwise, or even when it comes to us Personally to be making a decision. Db.C. F. Holton: Mr.Chairmaa. D*I.Gqu>ow8*t: Dr.Holton. Krs-.tr>- 'ixrmef 34 A tsocuUion 0/ American Railroad* Db. C. F. Holton: Let's go back. Are we going to delete that aew recom mendation in there about an engineer wjtb znyocardio-iofarctioo? Da. I. CoioowsKr: I would recommend we delete all and just 6ay: "An employe with cornary occlusion should be removed from service until he pre sents satisfactory evidence of recovery." Leave it there. Dr. C. F. Holton : The reaeon I bring it up, it is getting more and more difficult for us to restrict a man to yard work. The unions fuss about it, and they say, "If he is abie to run an engine, he is able to do anything." It is almost impossible to soy Jim Jones can only do yard work any mote- Then, another thing is, therv is a movement all over on railroads trying to abolish the position ofa fireman on this little yard engine where ouc man runs that yard engine. U'e arc gelling inlo u little ilaugvrou- territory ith the brolberfj'*i.' fin tii.it particular tiling. Dr.. I. (Joi.nowsKv: You ngn-- with *>; Him. we>iioufd stop after tb>Word "r eilielir > 'll re' 'll <r V. " ale I lei it go lit that Thai 1> 11 p then lo ll,e (`be ! Me'Inal (ilii. < i it, 1 nie win tin r 11 man i.- recovered enough (o go bach in regular eer\ in.-, yard tcrviee or even get a desk job for him, if possible. Du. J. ,M. 1.. Ji..\.-u.\: fa (here any further discussion on these recom mendation-'.' Dr. Harvey Nelson: I am glad to eeo a more simple form of examination blank. I think there still arc things that can be deleted. We have found it quite helpful to have u cheek fy.-tem throughout most of our blank. It is much simpler to fill out ami much simpler to review. The things we have del> ted from our blank am time consuming findings which we feel would not Isi dis qualifying factors as for example measurements of the chest and abdomen. We have arranged to have room at the end of the examination report for the comments that Dr. Goldowekv spoke about. We have also combined our re port eo that it is all on one sheet. The history and vision on the front ude and the physical finding.-, on the bark. Db. I. Goluowsky: Dr. Longeway's Committee, iucludjog Dr. Jensen, have worked a great deal on this form. This form is more or less a combination of many forms of all the railroads over the country plus a form that, I believe, Ken Carney can tell us more about that tin- llcn-arch Dureau in Chicago worked on. Although 6otue ox these things may seem out of order for the applicant for employment, we wouldn't reject Kim, it i< nice to know they have these thing* when we later go ium court. 1 would hl.r to have Mr. Carney give in* ju-t a eonple of minute> on that. As fur as the two pages go, that again ;i- made up with ihe idea i on could ieav it as two page*. You i i.uid pel it ,v< one page, that the lu.'lory form be mure or hiss Idled nut by tin: employe. Jt need not be done in the medical department. It could be done in il.e p<r*<mn<| department, us 1 roniempian. doing it. He bring* that >%, r miIIi boo I buvo found a great deal of help when, ub we litid inter, fal.-ujiratio/i on thistone* tli.it the employe* give. It is a great help not milv it, murt. Put in .-nvmg gm-d-Pi,- to the! employ wjlbont UIIV I'onM-hack. Carney, will you make a few remark*. Mb. K. A. Carney fKxeeutivv Vice-Chairman, General Claims Division, Director, Churns Kewarch Hureau. .W-umnoo oi American Railroads, Chicago, I Lafonaauoto demons! vide a goo atajnation As you n facts of ao allege very ception he- Mow, it u he trie* to c entiii,-,}. \ HI any mm, (true you * pmddi. an,. 'rl J | In j ||, a la a i, r ,.. one of tbo>/ Ii i. imjH that ah an-wm-d, },, omclxxl.v'K That f, !>. H. S' designated e.vuininc- h; YY have Just tvce year old. TAP, hired rejected bv know about body, a cop: yfraud was one he had s So,1 linn tection. Dr. ]. Or than eight< coronary to Dr. J. M Du. Wi-; /> J. ,M ^ Mr. JI. Chicago, U1 KfH'i-ifie re/1 aJ.*o thr nm ..is > de/ete that new reeom- a ail and just .--ay: "An m service until he jire- etficg mure and non*. . .jii.i ims aiiout it, .and > do anything.'' ft is rk any more. "i> r:nitti:ui.- uving tn whirr <.fic- tti-tn rum ous territory ibr should stop after the 1`hat is up thc-a to the red enough to 40 hark niro, it posable. ...fie these recom- f.irm of examination .]. We have found it ur blank. It ia much `am# we have deleted ad would not b dis cheat and ab>lomeo. motion report ;or the ,;>0 combined our rca on ih< front side ivmi lading Dr. J.mcij, r U-*sifoml>in.i(<ift . -o.-m that, I believe, .unit Ith-aituworked !> r ior ihc applicant a.'iw they have those ..i(ut<-suti that. n the idea you could the liistory form be lone in the medical ci. as I contemplate a great deal of help : the employes give r to that employe J Division. uieru. .tailroads, Proceedings of MtdieaL and Surgical Section 35 Chicago, Illinois): That is our purpose in making the application and the information called for on there rather broad and general, and not particularly to demonstrate to the doctor that this man in able to do this work, but to pro vide a good background in the event you do not find anything on your ex amination and im- do later bud some things; that would be helpful in n law suit. As you know, -.vc have very little eiiam e of winning a law suit today on the facts of an aceid'-nt. And, the suits are iming won involving employes who allege very serious consequences from very minor injuries bemuse of lies de ception hr pr.ieii.fd when he entered your service. Now, it is not di -ir-'d <>> get tins information to use against him except where hi: tries to take id v tillage of a <il uif mi for hr< l-tir(il to w Inch lie is not really I'hiitied. Vnd, it ' mi do d' luouitraU' Unit a man had falsified his application in any material resjasrt, you cun get rid of that man from your service at aoy time you wish whether it i.i one year or ten years or thirty years. The only qualification liemg that you act after you find the truth of the situation, and you find that he lias misrepresented in some major premise. Then it does give a lawyer, ad M r. 1 l.i'-klxTt here can tell you, something to work with. He used one of those. Unfortunately, it was not written in the man's own hand. It is important that somclxslv do answer all of the questions that arc listed so licit when ho di-s testify, and you do give him this paper that he has answered, he is tho one who has checked it off or it has been chocked olT in somctwxly'rf presence, preferably a clerk. That is, generally, our filling about the form. Dr. II. S. Kii.vyrn: I notice at the top of the examination form is & space dc-ignated for the full name of the cMininci*, but it doesn't indicate that the examinee himself is supposed to -ign that sheet. We have discovered unhappily this is a very important thing. Just recently, witbiu the past year, we had an incident where a twenty-eight year old switchman, who had been furloughed by us and went to work for the T&P, hired a man to take his examination because he bad previously beea rejected by the jiunta F<: because of a congenital back defect. U'o did not know about it al lb'- ii..,e bad bin*I him. This man wrote a letter to >omuhod y, a copy of which ;'-il into onr hands by means unknown to me, and the mud was picked up bv the fact that his Mgnaiure did not compare with the one ho ha>t >igned for employment i.,r ua, So, l think that could be a very important point later on for your own pro tection. Dr. I. Gopdowsky: l think Dr. .vuckwdl or Dr. Dowd paid a little more than eighteen llmi-aiid in a -mnl.u when- they bad ri -turned a known ooronarv to work. . Da. J. M. L. JmvsE.v: fs there ativ further discussion? . Da. Wight: (Off tho Record.) Da. J. M. L. Je.nsen: Thank you, Dr. Wight. Ma. Hablam IUcsbert (Counsel, Klgin, Joliet and Eastern Railway, *'s Chicago, Illinois): I would like to suggest that this form contain some more pecifie reference to the man'* military service, his identification number, and also the question as to whether or not he has ever been where he has had any ,i -, y'g.-kv,ftlarltv tLtirii i-f^fg rWygitViii 36 Attocialion of American Railroad* treatment through the Veterans' Administration. That ia a very fertile source of information. In the defense of law suits, if you have the identification number, and you have the identifying information as to where, if at all, he has received treatment from the Veterans' Administration, it facilitates your access to the Veterans' Administration records. You can get the Veterans' Administration records by subpoena. Da. C. F. Holton: It is so much easier if you have the man sign the release at that time. Da. J. M. L. Jensen: Is then- any further discussion of this mutter? Dr. Nelson: (Off the Record.) Dr. J. M. I,. Ji.nen: Would t!<> be on tin- history sheet? Dr. I, Gouioh.ikv: So, on the physical. Dn. J. M. I.. J.n<en: 1> then: uni- further discussion? 1 J u. V. M SriMM.t, /( ')>!( Sorrcoi,. Sr ml I1, Pmilir C`<mip;liV , Sun l-1 anei^co, California/: i would like to bring out w>* have a very similar form to this we have been usiug in United State.' Steel. We found it to be very salisfactory. Our men examinees have been signing this for about live years now. Where it says here: "Have you ever had X-rays taken?" We have "Why," "When," "Where," and "White dab-." Underneath that wo have, "Have you ever been admitted to a hospital?" Ask, "Why," "When." "Where," ami the date. Under that we ask for an authorization for release of any records that have been made available. So far we have beeu able to get the record* on this authorization. Dr. I. Goldowset: Any other comment*? Doctor Niles. Da. J. S. Niles, Jr. (Chief Surgeon, Lehigh Valley Railroad, Sayre, Penn" sylvania): If this is a periodic examination, shouldn't there be something about diabetes and insulin? Dr. I. Goldowsky: I believe this form is really to cover all exams, al* applications for employment, new employment, retiring, furloughs, special' periodic and promotion. You recommend there- be a note? Dr. J. S. Nu.l.-, Jit.: Ther<- must be some diabetics employed. I thought we should know whether they no- taking i/i'uliu or Orinu'o, how much and so forth. Da. I. Goloowskt: I think that belongs somewhere on the second page for the examiner when he examines the examinee to elicit and put on this form. I certainly agree with that. That is an ever-present problem. The man may not have it when he comes in for employment: may develop it through the years. We certainly should have a record of It. Dr. S. Leigh, Jh.: Wc have recently run into the question of giving privi leged information brought up by this type of lawyers. We have just had a good-eixed judgment in Richmond because the doctor that treated the man for cotnpour, pany that w. information, I ana just application u tiling about t Me Hacxj. tion form for General Clan mploymeut. eike this ?ugglemployed an mended tln-r> any treating t: information t? Dr. J. M. L Mk. K. Cam in which they I bility of that s: Dr. J. M.L Dr. I. Goli*o l/Oiigeway. This really haraising of hand.correction to thi This is a most Hackbert has to; It haa been tv this and then ea> the railroad indu.* "WelJ, you fellov one else has one i Probably you > fectly permissibh dustry and every < but they arc c ru claim department So, I would like and additions hav> tion for final adop is parsed that this final print,jig Now, tint bnui: is 1J:40. but, we " Dr. Wagner: Dr. I. Goldow.'/ ry fertile source .rr idoDuhcauon . ,{at all, he has your .wees* -OS. . dgo the release .natter? my, aati Kruu- iroilax form to , be very saus- ::vc hi * nowy," nave, ilave Where," ami / mv >rds i tin* ( cords >.urc, Pt-nu* '*, something l ..S al j*. m.1- I. I thought * much and ........-olid page : on this form. The man may through the Proceedings oj Mttlicnl and Surgical Section 37 for compound fracture of his arm gave the information to the railroad com* pany that was paying him ail of his bilb. Ami, he was disclosing privileged information. I am just wondering if there would be any wav in your pre-employment application to allow that, if necessary. Mr. Ilackbert, could you tell us some thing about that? Ms. Hacxbert: I think that is being taken care of ta the general applica tion form for employment that is h*ing worked out by the committees of the General Claims Division. A* 1 recall, the suggi-tM hum of application for mployment, which instead of just, going into rhe unsliea) history of the man "ike this suggested form doe, goo* into the question of where he was previously lemployed and all (hat sort of thing. In the .-(.and.ord rhiu.-os that are recom mended there are rather general provision* for the release of information by any treating doctors. Now that l think of it, there is also a good deal more information there as to the military history. Dr. J. M. L. Jexsex: Yes, I think they have their identification numbers. Mr. K. Carnet: Every privileged communication statutes in the states in which they have such statutes in that form specifically waives the applica bility of that statute in the employment form. Dr. J. M. L. Jen*kn: Thank you, Mr. Chairman. Dr. I. CiOldowsxt: Thank you, Dr. Jensen, for pinch-hitting for Doctor Longeway. This really has Ijwq a two-year work-up or more, and I certainly want & raising of hands. This again will have to be <a,rri*$ed and referred hack after correction to the Committee of Direction for final vote for adoption. This is a most important problem, as Ken Curnev has told you, and Mr. Hackbert has told you at previous meetings. It has beeo two years' work. Let's not raise our hands. Let's not adopt this and tl.cn -ay we ire not going to u-* it. We want to -tandardin: this for the railroad industry because we don't '.ant you to come along later and -*ay, "Well, vu f-Hows arc o-mg it. Whv do Mm haw -u'h for in, v. ir-n <,rucOnft else h:i* oik* of Till-o|.I ;..rrc-?'' Probably you will want to let your j>r>-**-irt priming run out- That is per fectly pormkyubh}. If we adopt this, Jet's adopt it for the whole railroad in dustry and everyone use it because most of our forms ver* good in ih**ir times, hut they are certainly now out dated and n use. to our l*-gnl departments or claim departments. So, I would hke to have a vote. All those in favor of, after the correction* and additions have been made, referring this buck to the <`omnuttee of Direc tion for final adoption raise your hand. don't sre enough haads. Then it is passed that tins be again reviewed by the Committee of Direction prior to final printing. Now, that bongs ns to our last topic. We .are running a little bit Isvtt*. It l* 12;40, but, we will cnmmnc. I- 38 Da. Wagner: There was no mention made requesting your motion. There was none made? 1' Da. I. GoLDOtvsKf: I tried to slip one over fast. Da. Waonkr- Just to make it legal, I so move. Dr. I. Gouiowsky: To make it legal, you have heard the motion from the floor. Dr. C. F. Holton: J r-TOiKl the motion. Du. I. Gols-ow^ky : We will have to keep it legal am] vow- again. All those in favor the motion. So moved. It is time for lun<h. hut we just have.- one more item on thi-* morning's program. We will tio\`. l.nYe :0i *!1 -l ii-rri ord di-< U.->i(Ui. .. , Whereupon, the meet mg concluded with an off-the-record disr.upsion. . . . The Tuesday y cal an<i Surgical ^ Edgcwater Gulf 1 Dr. I. Goidoffjky. Dk. I. Goi.'.o'u morning. I do i.u\ I have a trl< gr:.: "Du.- t" pr. Heflt wiift In- "J. U. tiw, I also have a letter "Dear Ire: "Mv wife ju doing well. I w "Yes. 1 had 1 am healing re things. "I think mi: do wain to he let nic offer m "L do hope cushion on you "3 pray this "Sincerely, Our first order o on Nomination*. 1 however, before boi (Announcements Dk. 1 >im ax Kv The (.\iaimittee and the following > of office espire mt Dr. K. M. t Dr. C. K 11 Dr. J. K. si Dr. G. F. C At our meeting ' c'UOD. TUcre motion from gain. .ids rootning'3 , discussion... /Vocetrd.iu/s of Mttiical n/ul S-trgicnl ''cciu/n 39 TL'hSOAY MOUNl.NG SKialON M.ueh 25. I' The Tuesday Morning Session of the Tliirty-Annual Meeting, Medi-. cal and Surgical ejection, Association ot American Railroads, convened in the Edgewater Gulf Hotel, Edgowatur Pars, Mi.-oi.-Hippi, at nine o'clock, a.m., Dr. [. Goldowsky, Chairman, presiding. hit. 1. tioi.uowj.nv: Before a.* undertake the real order oi hu-on..`.s this morning, I do have a lew .iiiinmiM-.-nn'iils. I have a telegram here: "Due to pressing professional duties, l am unable to attend meeting. Best wishes for a .uiccessiul meeting. "J. \i. Gandy, Chief Surgeon, Southern Pacific Hospital." I also have a letter. "Dear Ira: "My wife just brought me vour most welcome letter. To prove I am doing well, I want to answer it my-vlf. "Yes, I had a uuld coronary three weeks ago. The evidences are that l am heating real well ,uul in the tear future, will be back in the swing of things. "L think missing the meeting hurt as much as anything. Remember, I do wanP4ftheip wherever possible. I sincerely enjoy the AAR. Again, let inc olffr my services and euuperarion. "I do hope the report of my committee will make for interesting dis cussion on your program. "I pray this is the only .,ne I will i.ii-s for -m-aleT lo/.-n year*. "Sinrer.-lv, Waller dur !ir-t order of hit*ui\s this morning i.-> our report from our Commute* <n siMininati"ii,. I will i nil .a........ 1 I. or m m i )r. I > i.oi Iv.v i><c i:;-. r. port. however, heloro doing so, l have a lew more ;i:moiinerme01 *, {Announcements.) Da. IJf/Nca.v Eve: Mr. Chairman. Meiulx rs: The t 'oininii I.......... X'ooiin.iiimis met iu 'eer. iarv Parlor's >Hiec n March 7, and tin: following arc the member* oi the l 'oimuitlee of (hreelioti whose terms of ollice expire with the dn.-e of tin: i!;')* Annual Meeting. . Dr. U. M. Graham; Dr. C. h\ Holton; Dr. J. K. Stack; and Dr. G. K. Cushman. At our meeting we selected the following for the race, so to speak: ! ( f i r; >. v.S'!4 (WWW. 40 Association o] American Railroad* ASSOCIATION OF AMERICAN RAILROADS 3F MEDICAL AND SURGICAL SECTION # ANNUAL MEETING--MARCH 24-36, 1668 :* BALLOT FOR MEMBERS OF COMMITTEE OF DIRECTION (Indicate by an `X' the names voted for) Southern Territory (3 Year Terms--Vote for One) [)r. .1. M. l.miu' U. Chief surip-on, s Cl.v-niHaike and Ohio Railway, Richmond JU, Va. ! I >r ' 1 . Hr,Iron, ('l.hf Sum | ( Viilral (il Georgia ftailwriv, Savannah. Georgia. j J Jr S<mthgnti- D-igh, Jr.. (`hief Surgeon, ! Seaboard Air Liia* Railroad, Norfolk 10, Vo. Western Territory (3 Year Terms--Vote for Three) Dr. G. P. Cushman, Chief Surgeon, W estern Pacific Railroad, San Prmieirteo, Calif. Dr. U. I. Derauf, Chief Surgeon, Northern Pacific Railway, St. Paul, Minn. Dr. J. R. Gandy, Chief Surgeon, Texas and New Orleans itailroad, Houston 1, Texas. J)r. U. M. Graham, lUreetor. I bpanmont of Medicine and Sanitation. Tin Pullman Conipanv, Chicago C, 111. i )f. \V. J. 1/u.k'i-w *, \, t j,,. i Surgi on, I Colorado and Suutm-ra Railway, Denver, Colo Dr. llurvev Nelson, Chief Surgeon, SoO Line Railroad, Mimuapoiia 2, Micui. Dr. J. K. Stack, Chief Surgeon, i'hicugu and North Wi-mit/i Railway, Chicago G, 111.* 1 j Dr. J. R. Winston, System Medical Director, 1 Atchison, Topeka and Santa Pc Railway, Chicago, 111. I am gou tellers, Dr Are the Dr. Der mail of the Uiittee of Dr. Sba Dr. McLci Now, fo aoroething I don't w Vovir v explain it The VII you enti't I will tt Mb- F. for every than one eo that w Ifi that Now, I retire fror and road 3a. I si bal Totin Da. D .v exp Da- I social atefulJ) .ter b u*n y wouU He ia \V ouk motion Dr. xsrram: --c-v : LROADS 3 ;LRCT10N ne) Vft. ;ia. t fhxee) > ad. iii i ! . 1. T. ' uJt Medicine and oin. Colo. bicago 6, 111- tor, ,y, Chicago, 111. Proceedings of Medical and Surgical Section n Da. I. Goldowsky: Thank you, Dr. Eve, and your committee. We will have tbe ballots passed out now. While they are being passed out, I am going to appoint tellers and election members. As Chairman of the tellers, Dr. Deraui'. On Ids Committee, Dr. Cilia, Dr. Niles and Dr. McLean. Are they all present? Dr. Derauf, I am sorry. I have to remove you from your position as Chair* man of the tellers because we just noticed you are up for election to the Com* mittee of Direction, and according to our rules, you cannot serve as a teller Dr. Shaffner, is he here? .Ml right, you will ?erye with Dr. Lillis, Dr. Niles, Dr. McLean, as tellers, and we will appoint Dr. Ellis as Chairman of this group. Now, for the newer members, I am goiug to take a minute just to explain something for tho.<e here that mav be voting for the first time in our group. 1 don't want you to I . oiifu --1 the wav I was y.-.nrs ago. Your vote9 count for more than one vote. I i.liink that is the easiest way to explain it. The voting is ba^.-d on the mileage of the railroad you represent. So, if you cau't figure things out later, you will know why. I will turn this over to Mr. Parker. Mr. F. J. Parkkr: As Doctor explained here, you are entitled to one vote for every thousand miles of railroad you operate. Now, it you represent more than one road, who are member* of the A.A.K., indicate that on your ballot so that we will give you creoit for anv of the roads that you do represent. Is that understandable now? Now, I would appreciate if the t-liers would collect the ballots, and we will retire from the room for the purpose of counting tbe ballots. Put your name and road on the envelope. Dr. I. Goldowsky: your ballots. Voting.) Will the tellers please come forward and pick up Dr. Dowd: Would it be in order to viggcst we write a letter to Dr. Longev&y expressing our regrets of his absence because of his illness? Da. I. Coldowmky: I think a note from friends and people who have been associated with you 'luring the years would U: very welcome. I will give you Dr. Lougeway's address, and l uni *ure anything you write to him will be gratefully appreciated and will be forwarded to him. I scut him an official letter before. That is what he is answering here. If somebody has the time when you go hark, he will probahlv U- convalescing for unite a while; l think he would appreciate anything from our group. He in in Saint Joseph Hospital in Denver. Would anyone rare to make a motion? Dr. Dowd, would you like to mako . _ * motion we send an olHcial telegram or letter to Dr. Longcway? Dr. Dowo: I so move, vijjii.... The motion was duly seconded... . 4 i l JTW imm 42 A Mocuition of Amrrirsm Railroad* Dr. I. Goldowskt: It has bwn moved and seconded that an official letter be lent from this Section to Dr. I.ongeway expressing our prayers for a sfiecdy recovery. I think Mr. 1'iirlcer will take care of that. While the tellers are busy with counting these ballots in the next room, we will go in reverse, if [ might suv so. I have to go backw ards now for the report W' of unr < 'niunoitec on DisaUhu and Rehabilitation, our Chairman, Dr. James K. Stack. Chief Surgeon. Chicago A" North Western Railway. Again, you had his report sent to you a few weeks ago anti I !io|>o you have any comments ready. I believe Dr. Stack intends reading some of the high 2a * points, changes that are made and will answer nriv f|ue>iions. Dp. J oil- K. cru k ff 'hn f r-urgenn. Chicago and North Western Railway, Chicago, llhnnisj: Mr. Chairman. Gentlemen: You have our report as given la.-t year, and it is now, as 1 understand it. ojv-n for the draft as we have it here. It is open for general discussion l.eiore it goes to the Committee of Direction for their final evaluations. Is that right'.' Dp. 1. < bi.uira-M : I thmk so. Dk. Jaml.- K. Sm s: Dr. Wight had some comment to make. I believe* on the ndvisubditv of having something in there about tbc management of Jiabctes by the new oral preparations. Earle, would you like to romment on that as a memlier of thia Committee? Dr. Wight: (Off the Record.) Dr. James I\. Stack: Doctor (Iruham hail some comment about the con trol by the l' J*'. I'ublic Health Service of the itinerant restaurant, which the dining car is, rather than the local county, state or provincial government. Dr. It. M. Graham: (Off the Record.) Dr. K. E. Dowd: (Off the Record.) Du. James K. Stack: I think it was a very hard thing to define. We thought we would leave it flexible for those who want to examine n man again after he hail a e*,ld ami had been b>,me tor three ilaxs. That is their privilege. Those of us who <lu nut, it is our privilege not to. To put a definite time on it would Is; very difficult. So, we thought we would leave it ojien. Dn. I. Goi.ume-KV: To tlm individual railroad.' lo; J \ mi - h c i a k : ^ i . 'I h, o ii.tm.ie, n -juuvne nt o up Io 1 ta md,. ideal road. Tl.o'*', 1 think, are the only comments that came lo me during the jieriod since the publication of this new commit lee report Iln. U. W. Stockwell: (Off the Record.) Dk. E, T. Stahl (Chief Surgeon, Motion Rail mail, Lafayette, Indianan I wonder how' maliv of us hen- ....... . * iv under llus diabetic problem that do Hot allow diaU-ties lo serve on tram ojx-ralinn.x? 1 would hate to fare the task of Irving to weed out the known dialx-lirx 1 have nerving. -Not that 1 am defending the dialietien working in train o|)erauous, but ju*t the me chanics of getting them nut would. I am sure, lend to an awlul lot of difficulty; at h ast in my opinion . -3SC03" V . Dk. James. and that is w I expression "h man should u leave it up tw hether or n. Yes. Doctoi Dr. E.T.S of us at lualh mission we do Dr. I. Goli to answer you: or as Doctor \ train service, no (rouble at a Dr. E. T. S. Da. 1. Goli units. He is ox I imagine there do pick them : trouble tfbyw-l How about r can answer do. Da. E. T. Sr Dr. I. ColoHow many i taking insulin o How many <! ices on the roa.i Again, We ha. How many ; agents? Doctor W ue: Dr. J. li. Wix Fc Railway, C'l . First, 1 want this report but i Do I underst; letinx dlG, ,'iOtt, ' the final rejiort Du. Jami..- 1\ Dr. I. Gold anything voted approval. If p: .t an oixicia.1 letter -1 vers for a speedy ho next room, we ,.j\v f.ir ilio report a man. Dr. Dunes i { !,..p.; V','i r iv<> ; ~.i,w >/f th-* high \V.u.ru Railway, ;vi* <tr report as . ir:Ht as we have > ihe Committee of c.i make, I believe' :v management of ,l mmittce? . nl ab-.ut ti.e rollliuralit, a l.ich the M'lal gowrmuelit. : >o d'-tine. We i in igain ir nr. u. i:i`. .<:gr,t would . nt is up to tin* in* .c during the period i.n'nvette, Indiana): Miietic problem that [ would hate to face serving. Not that us, but put the me* . viol lot of difficulty; Proceeding of Medical and S'trqical Section 3 D. James K. Stack: There is a loin-iderahle difference of opinion ibere, and tliaC is why tin* committee clio-- ibis is on page .S under ``DiiibetcV - rhe expression "hazardous ocrup ition," as against a definite statement that a man should not work on the road, in tin* yard, m the office and so on. io, we leave it up to the individual medical examiner or ciiief surgeon to decide whether or aoc the diabetic's work is truly hazardous to himself or to others. Yes, Doctor Stahl. Da. E. T. Stahl: This statement is very positive. I just wonder how m.-tnv of us actually insist on taking .ill the diabetics out. [ mean. I am in open ad mission we don't, f jii'i .u,.ii*r iiow many .-an *av tln-v do. Dr. I. Goldowsky: I may lx* fortunate. I would like a raising of hands to answer your ijii-'.itiou. )u ..ur mad, any man m train service taking insulin or as Doctor Wight says an oral hyperglycemic ageut ia uot permitted in any train service, and l have not been against any three-man board. I have had no trouble at ail. Dk. E. T. Stahl: Regardless of how much iosulin he is taking? Da. I. Goldoivskt: It doesn't make any difference if he is taking five units. He ia out of service because he is taking insulin, and we know it. Now, I imagine there arc probably a few that got by us, and we don't know it. We do pick them up; they arc taken out of service immediately. I have had no trouble anywhere. Maybe I un lucky. How about raising of hands? How many abide by that rule? Maybo we can answer doctor's ijucstion a little more specifically. Raise your hands. Da. E. T. Stahl: In train service* Dr. I. Goldowskt: In train service. How many don't allow them, as we don't, in train service completely, taking iaaulin or hyperglycemic agent? Nobody has nad any trouble? How many don't, - r., l--t t .m run a:i r.'igme, but allow them iu other serv ices oil the road? Got a f.-.v u. ri'Again, we have a .filfiTvun? of opinion. That is liable to bang us some d iv. How many permit tiu m to run engines if they are taking ii\porgiycemie agents? Doctor Winston you wanted to say something mi this? Dr. J. R. Wrv.sro.v iSystetu Medical Director, Atchison, Tojx-ka and Santa Fc Railway, Chicago, Ulinoisj: Yet. First, I want to ask a tjnestion and, what I have to say applies not only to this report but the rc|xrts that urn; marie yesterday. Do I understand correctly that what we are proposing will supersede liul letins 216, 300, First Aid Instructions, ix-riiaps others'? Am I correct in that the final report will supersede the present bulletins? I'rd'.v' Da. Jasies K. Srxcs: That is right. * > * Da. I. GoLoowsar: I don't know it by number, Dr. Winston, but . . anything voted on here today is going to the Committee of Direction for final I D- approval. If passed by them, it will be standard for the industry. J i y* 44 Association o[ American Railroads Da. J. ft. Winston: Wheo we, ia tbia body, p&eeed on a bulletin te being standard for tlie industry, more and more we are, as individuals representing railroads, being subjected to review and criticism if we do not follow what ia V-.' ultimately shown in print in the bulletin. ^Therefore, it in pretty evident on the subject that you just mentioned, about insulin and train service, that we are not ail in accord. Further, it would be extremely difficult for us to ail get in accord in any reasonable amount of time. So, I want to suggest to the Committee of Direction that they keep in mind that more and more areas of limitation are coming before us, and we are going to have to live by the bulletin. So, if the bulletin says that a roan taking in sulin should not be in train service, we should be prepared to accept that challenge when it comes toward u* ici court, that we have erred in permitting such to happen. Not too Inin.' at'" 1 had a rather trying experience which I, as the Chief Medical Officer of the Sarily Fo, na- Called before an august body, and in this instance being the Grand Jury, to tall them why we permitted such aud such V eiigi .*i" i a man to oj-r::te a locomotive wjih ail of these problems that lie had. In cidentally, ii"':" of ih'm were of any Mgiuhc-vnce, whirl* wa.- most important for ii' lnt, I want t admonish the group that we are not the only ones who D scat arc aware of the variou- bulletin.' that tJiis group sponsors. So, let's be ex tremely careful what we put into them and be careful that we do not make it sound mandatory. I understand now that we will be given an opportunity to write to the Committee of Direction aud recommend certain changes and additions aud D of t morn take deletions in addition to those that have been discussed? D Dr. I. Gourowsm : Instead of writing it to the Committee of Direction, I would write it to the Chairman of the Committee whose name you have. There will have to be further committee meetings to rehash and go over these recommendations before the final draft is submitted by the Chairman to the Committee of Direction. Thu Committee of Direction, in turn, will go over it with a fine comb again. Dk.J. ft. Winston: Fine. D mitt D mitt sett! P, Da. I. Goldowskv: 1 would write anything further to the Committee. Naturally these things, both the papers yesterday--Dr. Olson's Committee on First aid, and Dr. Lonpcway's Committee on Developments resulting from Physical Examination.-, anil Dr. Slack's Committee--will have to have Com mittee meeting.'. All papers again will have to by submitted to the Committee of Direction for liual pas-age. Y<>U still have time, quite a lew month'. There probably won't be a Com mittee of Direction meeting before August. You have a few months to rehash these things in your own office and make any further recommendations to the chairmen. Dr. J. R. Winston: Fine. pag not T mui the has mitt beio Dft. I. Goliiowskt: Dr. Knowles, Dn Kstiwi.r.s: 1 would like to bill a Mory real quick. Saint 1`eter and Saint Paul were plating golf. Saint Peter tees off and makes a holc-m-oue. Saint Paul follows, mm tec- otT, ami makes a hole-in-ont*. When they are walking down the fairway, Saint Peter says to Saint Paul, "Now let's th no qU MMWtPt*' * III . .M'MjmWl.wp 46 AtiocuUu>n of Amen&in RAilrondt Db. I. Goldowsky: I accept the qualification. Dr. Kepner. Db. R. B. Kepner (Chief Medical Officer, Chicago, Burlington and Quincy Railroad, Chicago, Illinois!: Oo the Burlington Railroad years ago, certain types of anti-glare colored lens was approved and furnished to employes at cost, but in recent years the use of such colored glasses or goggles is not encouraged. At present, with the increased speed of our trains, the increasing establish ment of centralized traffic control and fewer train orders being given, the prompt and accurate recognition of colored sigmas i*> o( inercas-ed importance. When you say they must not be used and a trainman i.s found to be wearing colored glasses while on duty, even i hunch in his particular r.n-- they may be indicated, disciplinary action is called for with po.-.-iblr repercussions. 1 wonder if any of the railroad.- here represented have written rule? or regu lations cither flatly prohibiting iln- u- m gln-.- - wit it colored hn.-i- or speci fying any ceriain type of cnjwred leu- ih.ii may be permitted. T % Die. I. Goloowsky: f am going to have Dr. Bennett answer that. I think I have a little recollection that there was only one Jens that we might approve if there were to be any approval from this Section. I think Dr. Bennett can tell you more about it than I cau. Dr. H. J. Bennett: Our committee worked on that for five years. I went up to New Haven, Connecticut, and also corresponded with the Air Force, Navy and Army, and got all their qualifications. We ended up with the specifications used by the L;. S. Navy. That lens at that time was put out only by Bautch A: Lorub. Since then other companies have put similar looses out. That is a gray lens. Back as far as thv Savannah meeting, that waa the time we read those specifications and recommended they be used as a basis for comparison. Dr. Wight: (Off tbe Record.) Dr. R. J. Bennett: G-15 which is Government or the N-15 which >6 Neutral. And the "15" mean.- that i: allow- fifteen per cent of the visible light to come through. Dr. I. (joUiou-ky; 1 wonder if Mr. ll.c l.bon would give u- a word on I he legal implication.'* if we have four or live road.- thai are allowing men to use tinted lenses and the rest of the xy.-u-m again i> saying they shouldn't be used. Mr. IIacebert: I suppose that is no different than any other safety practice or medical practice ou which the roads disagree. If you get into a law suit on it, you have a train accident where the. contention i that thv engineer couldn't ,*vc the signal.- bi-eau-c he wa- wearing colored glasses, aud you will ruu into the same coutiict of testimony. Thv plaintiff will put on his experts that they don't do that on other railroad-. The railroad may defend ou the groutid that certain railroads do. I don't think the rules make much difference on that. Db. I. Goloowsk Are our toiler? br. is not back, so I an. At this time 1 an didn't see him at a Hp is coing to ac I\en. Mb. K. A. Cap-s of the comment- > this Southgate Lei. ruined my reputat. s;iil furtfi* r in a r> . force for one full <i A.A.R. But, Miiccrciv, I those it 1 could hcl; to be of service to U helps us to und. here. I don't know wh giving legal opinio:, taw if I attempt to coming Iwcau-e he Now, the topic t: thing much. 1 cm. interested in the he We started to tuu the claim and litig here as yet, I think We now have a when* compeosatio medium of a verdic' The highest amour. the lowest scttlenn Now, the diffcriu have been well sc. everybodv. Ever; patently involved i The large-l grou; men and five firen two yard masters, tcnance-of-way, tv groups. But, the factor, ing, and what you a little far rvachin.- Fot example. yinhalation of fumbeing brought on lifting or extra elb' w visetter? i.ngtou aud (Rainey ; yi'ica ago, certain d to employes at - of goggles is not tca-mg cMabliih -.eiug ;iv'-n, the iSt-d import MtM. md to be wearing .- .'wse they may be fcoasions. .-ten rules or regu:r*ti lenses or sped* 1. ver that. I think ve * -lit approve :ve years. I went n the Air Force, :ied up with the ;me was put out "ut similar lenses ng, that "ns tho : used as a basis N-J j -vtll* il is it <>l lln: vi -ibb; ox a word on ...lowing men to t they shouldn't .y other safety y>ti g.-t into a .<{1 is Unit the ><t glosses, and will pm >>a his td mav defend r inch Proceeding* of Medical orul Surgical Section 17 Dr. I. Goldowsrt: Thank you. Are our tollers back, or do rimy have a long count out there? Mr. Parker i3 not back, so I am just going to continue right aiic3d until they come back. At this time I am going to call upon an old favorite of ours. I think if we didn't see him at a meeting, we really would miss him. He is going to address us on Claim and Litigation Problems concerning the Heart, by Mr. K. A. Carney, Executive Vice-Chairman, General Claims Division and Director of Claims l{<-rarrh Bureau, A.A.It., Chicago, Illinois. Hen. .Mk. I\. A. Caknkv; t am going to he awful careful in what I say in view of the comments which have mine to me in this meeting, particularly from this ouuthgate Lehigh. : Laughter) His country-doctor approach has about ruined my reputation for astuteness. Then Dr. Bennett has compounded it Mill further in a recent trip into my otlico into which he disrupted the entire force for one full day, on behalf of the Medical and Surgical Section of the A.A.H. But, sincerely, I am delighted to be here; wouldn't want to miss one of these if I could help because really see some wonderful opportunities for us to be of service to each ocher. And, of course, we are a rervicc organization. It helps us to understand your problem* a iittlc tatter when we do show up here. I don't know why J/acktart comes except that we hod he is very helpful in giving legal opinions. I'm not a lawyer; I'll be involved in illegal practice oi law if I attempt to answer too many of those rpiestiorvs. .So, we hope he kts.-ps coming because he is very helpful. N'ow, the topic that I have here, I don't think you are going to learn any thing much, I can give you, perhaps, a few ideas as to why we ought Co be interested in the heart problem from the claim and legal standpoint. We started to make a -cudy of what has happened to the railroad both from the claim and litigation standpoint. While we don't have all the reports in here as yet, I tliink you might bo a intle surprised to hear what we do have. U e now have -tudv "i. I -ue'-, around i hundred and ;<>m>' odd -a-.-. where compensation has i.r-idv a |>hd itlnT voluntarily or through ih- ui' dium of a verdict mid j i :gns- nr in .;i r., md the oigiie,t vrdn i. m The highest aifioiinl ;>ud i * r'llI.Min I ii-fi- Ii ave t---n ila.'iOO, AJ-l.'fM), and [In; lowest settlement was >7*1). ,\o;v, the different members -,i the various nail s involved in tiwe. problem* have been well scattered throughout the entire industry. mean, theft; i* everybody. Everybody except claim agents, doctors and lawyers' are ap parently involved in some form of heart condition which has been compensable. The largest group happens to be in the engiaemen. There arc twelve engine, men and five firemen, eleven conductors four switchmen, twelve brake-men, .two yard masters, thirty mechanical department employes, seventeen maintcnance-if-wav, two store keepers, two baggagemen and ton miscellaneous groups. But, the factor, the precipitating factor, has generally Ix-en kind of interest ing, and what you might expect, I presume, although some of them 3eem to be a little far reaching irom a claim point of view. Fur example, you have six exposures iu bent or cold. Vuu have fourteen inhalation of fumes. Vuu have six that collected because of the condition being brought on in their ordinary work without any extra hazard or extra lifting or extra etlort hoing involved; three from nervousness, and six from im- 48 Ataodalion of American Railroad* proper care or work, and one while working while sick; one from fright and one from a fight; falls, pushing, effort and all those things. Extreme lifting effort are in thirteen; nineteen indirect trauma of the chest out of a hundred some odd cases. There have even been some interesting things happening outside of the in dustry. How many have heard of this Marlin Commission report in New York? Any of you? It may be of interest to read at least a part of it to you because it does highlight some of the things we are going to be interested in. This Commission was established to determine what was happening to compensation out of the New Fork Workmen's Compensation Act. Governor Harriman selected Judge Callihan as a Commissioner to investigate the situa tion. The conclusions on heart case? were kind of interesting. For example, he said; "Briefly, the co.'ichi-ion- reached were that work dues not produce heart disease Coronary o'-cln-iuii ic preceded by coronary f-Hrn'd.-. A coronary nrrJuMori oeeurtinn d'nm;' imi- mi. U heavy woi 1. without efigrigmir in lime uni ev.-riioti i not -..-naHv r-l..i <i lo employment. The metrical pro- ie--imi i- about event\ divide.) *m u h' ther strenuous exertion or emotion;.I di-terl ui'-c- can prodm-.- an o/vlu imi. with the emotional factor being Con-i'h i"l i" piay a unponi-.ru. ro'.t than the phy-ieai, and the lime spread between exertion also being of material importance. Sub.wr|iiet infarctions :it< nut related to earlier ones. "It util be seen that many award- have been made upon the theory at variance with thene concht-ions. It is also affirmed that many claims in volve physical strain or emotional disturbance and pre-existing pathology and to lh- extent of the latter arc illogically charged to the cost of com pensation. They determine that the degree comparative causation be tween the two appears ever in the present state of scientific knowledge, completely speculative except perhaps ill death cases where autopsy is po tide. "Until some instrument ur criteria for measurement arc developed, any allocation must necessarily he arbitrary. This, however, is > reason for dogmatically saying that the entire cost must be borne by the compensa tion system. "The economic pattern of business is seriously affected by baviag com pensation costs thus improperly expended." Now, in the survey, these arc the general statistics they quoted: There were 398 physicians who answered a questionnaire sent out by this group for the purpose of determining their theories in connection with the problems that will be related here: >1) Work does not produce heart disease, 99.9 jx-r cent against 1.5 per <*ei.t; (3) vomnnnr- from urtcrio sclerosis or conic other form of coronary dn-'m-i* mu-i jum \i.-t in an individual ivho suffer^ a coronary occlusion or nnncnrdmi infarction. 4 per rent againM b.3 per rent: i.dj per forms same type of moderately heavy work without engaging in unusual exertion or strain ha- tn* injuriou.- effect upon the heart, a myocardial infarc tion occurring during such work doe? not causally relate to the employment, 88.(1 against 7.1 per cent; pi) Mib.'equcnt attacks of myocardial infarction are not causally related to the first attack, the underlying pathology of the coron ary vessels of the heart. 83.f) against 12.9 per cent; (5) opinion on the alTvvt.of strenuous physical exertion or <-motional disturbance upon the heart, di vided, 4b.0 per cent considered that there was a causal relationship between strenuous work and an ensuing myocardial infarction; 49.5 per ct-ni did not. ''T - , . -x - -. v r The gener. bringing c whether a (roo his r. pet cent ft Anyboo be happy We will be .Another State of N tnendouip Board's dc category s a restrain l,\ hi- rn nod a bit. I:. the ay fr<>: ufv the acase? invi I am gc about itfuc*i of tu Now, sc lack of a to take ] and infor might be Our ba has to dc proMcm lawyers to inter] vocate t That known it The doctor roaico to i*.TV the ifid lioU'" t< not done yourselv two mac Our the ind lor em nicked 'reads ; dick; one from fright and *? things. Extreme lifting :he chest out of a hundred .ppeniag outside of the iareport in Xow it least a part of it to you going to b inlef^ted in. 'vti.ii was happening to Ait. ijnvernor r to inve-tigatc th<t situantorestiiig. For example, ,rk does not produce heart .,.iry sclerosis. A coronary .ork without engaging in jvment. The medical pro ems exertion or emotional emotional factor being ::o ph'-'teaJ, :nd the time i ntp 're. Subsequent :a>!< UpMi theory At ivil t It at oiAtiv claims in.A pr.'-- M.-uni pathology atged to the cost of commparative rausatioo be; of <ci*-o!;!:c knowledge, . cases where autopsy is ,;vQt Afc FiVclopvd, any -'..vt. . ; von for r-..- '.v .......... rnpenca- d ! ivmg com* 3 llw-y quoted; There mit '!!< croup lor .n ,*nh rhe prootems :r in <i..je-v-e, `j9.9 per ii roi<ii or <ome other i n t.o -ua'i-r-, x coronary ii 3 per cent; 1.3) per* : engaging m unusual c. a myocardial infarc- *e to the employment, ocardial infarction are lithology of the coron- ipioion <,n the (tlfecta o iin'>o rti.r In-iirt, di* r i.ho K op between at did not. Proceedings of Medical and Surgical Section 19 *. The general opinion tvaa the emotional factor plays a more important role in bringing on such an infarction than the physical. Opinion was divided on whether a person has a permanent-partial disability after be has recovered from his myocardial infarction and return to work and is asymptomatic. -15 3 [r cent Mt there was a .inability; 47.9 jkt cent that then; was not. Anybody who might bn int*r-'tcd in those conclusions and >o forth, we will he happy if vm mil indicate to Mr. Parker that you are imerfxted in that. Wo will be glad to furm-di v-m c'pivsnf it. Another i-onsmcni tbit v.i)) be inter.-Mug by tin: Bar A.--ori:ition of tieState of N'ew York, b.- au-c: ih-- lawv.-r.-> wore getting i-orisfious of this tremendous problem, w is rather i::r--r*--tiiii and may be int.-re-ting to you. The. Board's decision indicates that they have in recent years placed in the accident category such injuries as riding over rough roads which causes back injuries, a restrained sneeze which resulted in a fractured rib, criticism of an employe by his employer causing emotional upset followed by a coronary occlusion, and a bite from an insect which produced a rash. In the court decisions, the two most pronounced examples of the turning away from the earlier requirement of a strenuous physical act or occurrence ate the cases of routine exposure resulting in disease and the so-called "heart" cases involving the concepts of strain and exertion. I am going to quit I liking about the heart Irecaust* 1 don't know a thing about it. t do mention these things to yon so that yon mav know mere is a fund of material Wing rnilerted bv our olfici*. Now, som<; i>i inn, p.-rhajw, in mv eonvor-ations with you have indicated a lack of awareness of ,'ome of the tlungs we arc set up to do, and I would like to take just about ten minutes tp give you a little bit of background material and information, as to where'^mu might come for some help, and how you might be of some h.-Ip to us. Our basic philosophy in connection with this particular pha^e of our work aoa to do witn the fact that the railroad industry today is suffering from a problem that i- not :.:r *t.o in.*:irar:<-** or any other group. I'l.uiitiffs' lawyer* b.;v<* ---t out : Make inure injur.r-t, lo make more eorviuiui.s runject to interpretation of injuries. And, th. v have a.-ked the d<vtor to be -in ad vocate to ri-li.ibiiifat'' r * p iti- rit :u, .a. idh is well is pin -i.-dly. That is *->-rtaitly h.f-ign lo the throned of medical practice as we haw all known it. The thing that <; are int--rest''d in ;us an industry, of course, is the fact a doctor must be completely honest and objective; he rhoukia't favor the rail road company or his employer any more than he does his patient. It is possible to serve two masters because, as [ have repeatedly told you, the attitude of the industry is that we want to compensate people for what has actually been done to thi-m, but we don't want to pay them for those things which we have QOt done. You should be honest with yourselves, and, if you are honest with yourselves, you arc being honest with both parties. You cao serve, therefore, two masters superseded by one desire to do right. Our bureau has a clearing house. We get reports of all the ranee settled in tho industry. That clearing huu* hiuj tvery helpful iu clearing applicants for employment. Most of the railroads are doing lluit now. I-u*t year wi; picked up <*x Imiidrvd prior records on the reports w got. You have been jpveo information. We don't think you ought to-disqualify merely because somebody else disqualilied them. We don't think you ought to reject them 50 Aasocioiion of American Railroad* because they bad some condition two or three years ago. It is information to you oo which you should base your further examination, determination whether or not that man is a proper physical specimen for the job that be 19 going to be required to do. We don't wmt to do anything to keep men out of work unless taking that man on will bo a danger to himself or daager to his fellow worker. We are making all porta of invMtiirationn with regard to all the serious in* juries to determine how these miraculous recoveries happen that you hear about from time to time. We art finding out that these men who have alleged total and permanent disability do make these miraculous recoveries, are work* ine, and are engaging in occupation^, comparable to that which they were en gaged in at t!v- lime of tig- accident and at the time they made- the representa tion of pi-rui.tn* ni injuria to tit- court. Iti cently in Chicago, it might t>- <,f interest to you to know, and why I was glad to ii- ar tlc-c comuc-nt- about i- ine careful about what we print in these meeting'-, c.v u-ing t .-p-iic-ii iv-ird- of many nu-iicuMegnl men from the phtmuTV M'b- who have -jvih' : lo gr>c<js uliu have p'lbli.-hed pupi-rs oo varimi.*. T.co >i-,i t..r- in < 'h.V.u-M in a rec-t,r trial wii<> arc vry pro- f< .'ioual t- ilc r- Mid a no a i- ic!v involved in a case against the New York Central were eoiitroiit'-d with material we had gathered upon their prior speeches, their prior t'-Uininac, jury deln't believe them after they got through testifying b--cau-*' iU<-c p-tibi-d exactly contrary to what they had delivered in papers arid other scientific gullierine.s. That is the sort of thins lawyers need today in defending railroad cases, information about what duet or* who are eventually used by plaintiffs are testifying to. We ask tin- railroad.- iifc-n they report these cases to us, we send them an additional form iv-kim* tor nil of the material, how the report of the plaintiff's do-tor differs from the report of your own medical depart* meor. and in what sense is that report wrong. We can't determine that as laymen. You, as doctors, have got to do that. Unfortunately, I don't believe many of you doctors have had those tilings referred to you by your own compame.- for appraisal. I would like to say this to you: I think there ought to benW-ttcr liaison between your claim-legal and uv-dica) departments to the point whore any employe or any claimant that you have had under your cure ''ilects damages lor a cause* that is un related to the in/wyies you treated th- Juan for or is over-exaggerated, I think you ought to know about that. You ought to document it. I think you ought to make it available to us. Yon are the only one- who ran do it in an ud~ quate manner. Our statistics have been very helpful to them. We are not taking any par ticular side in tin- thing, but do think w<- ought to know what is going on from a practieal siandpoinf. Tin re lo? bo n t,,> much theory advanced with out anytiling in back oi it. W < arc tr. ;ng 10 document those tiling". I would like to furt her here, and 1 would like to be a lit tie nmn- of wryire to you. I think we failed you m one It occurs to me, and I was re minded of it the olh*r day, we promised to send von some information some time ago about the decisions of the National Uailroad Adjustment Hoard as they pertain to the various phases in which you might be interested in return ing men to work under certain conditions, what you had to do about sv threr- mnn board. That is really not your l.usiiw--< in one re-peel, but it would be helpful if you knew what the board w.-i* doing. I tliink we can get that material again together aod separate it, the medical part from the other parts, aod see that you do get it if you express a desire }- and an ioterwt i an authoritative departments- Oo your applwith that part c of tbe inchvidua taikoads have g: Our purpose in vantage of an h frauded in these and a bait timein tbe cost o: i'A extortion more I am going to he in a pre^ the B of UT. I don't know in give you a >' or since 1 have s they arc doing The Legal Ai the members oi they get their counsels throug basis- There is That regional Lodge of the L regional inveru come out of th ail. He is supp he charges oil as his commit Sow, in pre of that opinion Originally leaving the to Louis, they ba *(-m. hetweon h:i been join { well. 'Yc are hv the doctor DR. 1. Go Carney at oi Harvey. Dr. get informs doctors and .3 iniormiL0*1 t<3 mmation whether nt he id gwo* t0 men out -Ur to hii tcHotf ,i\ the -ettoua mn ihat yo'i h'-ar ,vho have -.dU'gnd v,.tv!. uf` v.r\C. h they w.-rc en- ,,(. vnta- ;i,,,i why l *** v.- j.riut in these ...d.-al *oa {r0I /ii.ilii.J papers on . ho are very pro* :u9iUufc the i upon their prior a after they got , what they had ,, r. \ cased, ''y'p. U ace . ,-asc* 10 us- we ,t how the report medical departctercniDe that as ;lid those things j like to -av this out fLiim-Wgal auy G-umalK . I V ,r i I|ll- _ , \.-t. % i o-k . _ . 1.-Ill ,r n "I ' tl.ing any (i.irh It .! going OQ . Ivuuvd vtlflhiues. mure of service . au*i l '.via ro.urtna'.ton mmo 'fre-m i'orifii na rented m returni .kl'.ult ;l *kr>V>-* out it would be . it, the rn<-Jieal *\pre.d & (i.'.nre I'roccC'iinos of Method ami Surt/ical Section 3t and an interest in that. We will be glad to do that. Please don't use that as an authoritative thing. Vou have got to clear with your own law and personnel departments. On your application forms ami things like that, please don't do anything with that part of the examination form that has relation to asking ipiosiions of the individual's past record. That is the moat important thing that the railroads have got to have done today on which to keep from being defrauded. Our purpo.se in having mis information is not for the purpose of taking ad* vantage of an honorable claimant, but it is to keep ourselves from being defrandi-d in these cl.inns. It. i, not an .icridml that we are now spending one and a half times aw imich J r our claim -rU lenients over ami above the increase in the rn-t of living tint w .-re ten v-irs igo. It is duo to this medical-legal , timie than aitv other -mgie i.-'clor. 1 am going to go on to one more nung that is interesting and is not going to be in a preaching line, but l know iiiat some of vou roav be interested in the. 11 of ItT. I don't know how many of you know how the 15 of ItT operates, but l want to give you a thumb-nail sketch of it because I have beard some words today or since l have been here which indicates a luck of appreciation as to just what they are doing. The Legal Aid Department of the 11 of fiT is not supported by the dues of the members of the legal aid problem of the switchmen. The only way that they get their money i3 through the lawyers. They have eighteen regional counsels throughout the country. They take a co->e on a twenty-rive per cent basis. There is a regional inv<-.tigator appointed in t-arli section of 1 lie country. That regional invcMtgutor is paid a salary. 11. is jjuid a salary by the Grand Lodge of the brotherhood, but the iuwvcr, regional counsel, who supports this regional investigator reiitilmocs the Grand Lodge tor his salary. It doesn't come out of the Brotherhood at ail. It doesn't enter into their accounts at all. He is supported by the lawyer. If this man is paid five thousand a year, ji# charges otf against those advances (and they are called advances or salary) as his commission on case.*, ten per cent of the lawyer's fee. Noiv, in proceedings in Chicago here recently, I am going to read you part of that opinion, they have outlawed .ui of that kind of activity completely. Or'ginaily the B of RT took a five p-r "nt cur ,.f the twenty-rise per <<01 -ivt/ig 'iie la wyer t .*. -nt v r (:,r. d a me- \#.,.ir,g wr*us 11 Meet) i:t St. Louis, they have al>and',m-d 1 i. > t. ' - ..v t l,*-v li tl, d it Uif- >ugh tins in<.-nt l>"tw ceil n gion.d ci,u:i--i: p gcii d >m- I .`upports !!; ntiro L-g d \ri I Vi p.irt meiit <ut Is.* b.i-i.i * ini 1 i..i v,- oe m j. u. d ;.< In ejo.-mg, 1 want ;. >,u lo know il.ti. iii>- \l. dn .d-la gal t'.mmuttee windi has been jointly set up by your ><'>(>,m -itnl our divt-ion is functioning wry well. Wo arc all very irippy .ii,ut it md particular!-.- ivith the interest taken by the doctors. I urge you to <oniiM;e to support it because I expect id the next couple years wc wl havesomeuting mat we will nli b immensely proud of. Thank you very much. ( Applnu-c Dr. L CoLpow-itr: Now you know why [ .-ay xw can't do without Ken' Carney at our meetings. Harvey. Dr. Nku-jon: Might I unk Ken Carney m; `|u. .ition: 1 understand you get information on rases that corne to m.d. J;< you get information on the doctors ami attorneys on cases that arc -ntlcd without coming to trial? Dr. Neuson: Ail of them? Mr. K. A. Carvky: All of them, whether they hove lawyers, whether they are tried or not. We have the name of the doctor, nature of tbc injury, the disability, whether total or permanent, or what percentage. Dr. Neuson: What the doctor chums? Mic. K. A. t' win tv: W hui t !.< duel' >r claim.-. Then, ij tin- duetor claims there is ;i disj):irii\ Iwfween tin- two. there is a question that >:iv: ``AA';<^ plaintiff's m< iii.-i( gtn--ii eviggcraicii'.''' !i tin v answer "ei-s,"' send them ;iii addition.,1 i< J l-.f Uh.it ti.ev " III do i- inn-nit you at that tunc i >11. 1. I Jot.imil.-1 v Vu;ir I 'h.iijn.-iM r- i>i t.il,. a jrru;.Mtier- ;u i In.-. trim-. UV il<. h:.ve .ui a l-bi - - l;.i- v >>n tin- run- oi trauma in cardiac disease. Rather than have y<u interrupting right now and ask Ken Carney questions, I th.uk we \uii uait 'tii later. We wn'l yd Ken Carney up here. We will have Dr. Burch up lu re. UVIi let them tear each other's hair outI am going to give you tin: report of the tellers of the election, and then I am goiug to call a bftcen-miriuU: recess for meeting of the new Committee of Direction. The report of the tellers of the election: Dr. Southgate Leigh representing the Seaboard Air Line, elected to the Southern territory; Dr. Harvey Nelson representing Urn Son Line Railroad, elected for Western Territory; Dr. R. M. Graham representing the Ruliman Company, and I >r. J. K. Stack representing the Chicago W Northwestern Railroad have been elected to the Committee of Direction each for a U-rm of thriH* years. (Applause/ We will have a mv" of fifteen minutes, and I would like U> make it hliei-n nurmie--. Re l.m-h here !.<r:ius- w>- want l> get mi with the show. We must finish around twelve-thirty or twelve forty-live at the latest. Dn. I. Goldowsky: I am going to take a minute before I have the next speaker to jus; announce to you at this time that at a meeting of your Com mittee of Direction, Dr. Ben Stockwell was elected Chairman for the next year. (Applause) And. Dr. Jim Stack was elected Vice-Chairman. (Applause! Now, as lung a? tlwy got rid of nic, I am not going to give this job up. i'm going to continue f>r a wiiili-. ] do have one hitle important thing. Tim Committee of Directum has di*eussed tin* inri tun; place for next v ir. Voij have a rimie>', not a big rlmiee, ul Detroit. or Chicago. That wn- done for very obvwuta rea.-ons. Wc have been away from Chicago a hmg while, f think we hail belter gel back clo.se* to it. Otherwise wo mav not have nnv meeting. So, you have a choice of Detroit or Chicago. Ail those in favor of Chicago raise their hands. Raise them up high because I got io trouble last year. Sixuwu as I count. All those in favor of Detroit. IM h-uer appoint tellers here. Thirteen; am I correct? Sixteen to thirteen, we wiii meet in Chicago in Iboy. The time of the meeting will be decided by the Committee of Direction at some later date. Vou will have some further notice at that time. | lijuress us on Georgia Raiiws I am not gou some awfully a. Dr. Quattleb- Dr. Quattu. For all pracii right colon dif? logically. Th.ii as the mid por,. course, arises ir from the sujkt. its iyniphati'- c inferior jwo-ie. thinn>-r und m< more liquid, cut be diverse tn cloften manifest t loss 0/ weight s more apt to nu obstructive syrn lo addition, t tions that AiSi-ri organ. There- vaive, and (3i " The npjicndi' abdomen that cappcodieilis ma operating for ap of the cecum ms by obstruction are cot sufficient kept under codst The competenevaluaUtiK and ileocecal valve ileocernl valve alrucUuu. Tin suaceplioa. In eighty per a very limited have a mesente where within greatly dilated symptoms freq of peptic ulcer colectomy ma> to cause one . I*.*- wr.- v 11 1l 1 ca.vi that is settled, i-iw^ets, whether they .uiro of il.e injury, the 5-'"S* U 'I..- ..... -.1 - I iNi:* ;um iii.it -.ia <: "H t ' \ . -fn] ifii-in , a aM.t tunc. -o a prerogative at this ttna in cardiac disease. . f\en Oirney questions, up mre. \V ivJ have .iir out. :,<v tiou, .uid theft I >i`- w Committee .tale l.-.g:i r'j/f,'xenfl|ig .v: Dr. Jl.ir.vy .WDon T-rmory; Dr. R. M. I. K- -Stack representing '.-d to the Committee of .1 like to make it liuoeri Ui {!.< .fjoie. He* nw*t ! lU-t, i iw t:te next . 4 -i . .>:r v'oin1 h or;;:.in : >r thi: text -Ch.nrm.iu. t \pplau.-e) o give tins job up. I'm . ' of Direction lias dis..oice. not a bin choice, ious reasons. We have id turner net back close i. you have a choice of ..e them up high because os ia iavor of Detroit, cf Sixtet*Q to thirteen, 'not will be decided by i .mi imve nomo lurthcf l'rocr<uliruj3 nf and .'-'uryicn! .Serf ion .'d At this time it gives me great pleasure to call on our next speaker who will address us on Lesions of the CYamim, Dr. Julian K. Quattlcbaiim, Central of Georgia Railway Hospital, .'avamiaii. < h-ori'ia. 1 am not going to give Dr. Duoltlebaum a swell head, but Dr. Holton said some awfully nice things about you. Dr. Quattlcbaum. ! Applau.-o) Dn. Quaiti-kiiai u: Mr. Chairman and Ontlenim: For all practical pnrpo*-s, the colon may la: considered a dual organ. The right colon dilTers trom the left einbrvofogicallv, anatomically and phv-uoh-i'icallv. 5 liit. par t *1 ilie 1 n>u i-l i-m , o. bug trorii t le- impuila of \ .iter u lar as the mid j-'-iol ! the I riinV'T-r ic.fi.n ui.e-* fru itw mid-gut. 1`bc hit, of course, an-es from i he hind gut. The right colon receives its blood -opply from tiie -uju rior uie-smlorir '.--els along nilh that ol the -mail ho.xi-1, and its lymphatics dram along these vessels while that of the left colon ia from the inferior mesentenc vessels. The right colon is much larger. Its walls are thinner and more permeable; the diameter is greater, and its fecal content ia more liquid; consequently symptoms arising from the right colon are apt to be diverse in character aud are more numerous. Pathologic conditions more often manifest themselves by systemic disturbances such as profound anemia, loss of weight and strength and prostration while those of the left colon are more apt to make themm-lvi-s known by the appearance of gross bleeding and obstructive symptoms. In addition, there are three anatomical factors which play a part in rnndii ions that Aifccl i he right colon- We con.-idcr r he rcruin and right colon .w one organ. These anatomical factors are: (1; The appendix; i`_M The ileocecal valve, and -'if Tim mobility of dm colon and c-c.uin. J.ESIONS OF TIIK RIGHT COLON The np|>cndix may at times produce mptmns related to the right lower abdomen that cannot be differentiated from tim-*; of cancer, fn elderly jk-ople, appeudicitw may l>e the tifst maiuicstation ot carcinoma of the cecum, la operating for appendicitis in . !! rly people. )(;> -tumid remember that e.uicer oi the cecum may he tier primur- 'ion. and the appendix secondarily involved bv obstruction m us op-tung im-i uoacI. If '.l..- tiitdingx in 'he .ipprtvitx ire not .-uiiiriefiliy eb. m.. d 'o a.lam the -.mptotn.-, Ue: patiedl .-ho'iid r,<; kept under con.-tant oi*-ervauou .ml X-r.ty -todies made after a few mourns. The competency or tncouipeUmcy ol the ileocecal valve is inijmrtmit in evaluating ami treating obstructive symptoms .iri.-ing Irotn the colon. The ileocecal valve may also be the -ite of new growth. Carcinoma involving the ileocecal valve may give symptoms simulating npjvendkitis, or low bowel ob struction. T'Jiia type of lesion may also precipitate acute ileocecal intus susception. In eigbty per cent of individuals the right colon is taxed, nod the cecum h** a very limited range of motion, but in twenty per ceot the right colon may have a mesentery, and the cecum may become so mobile it can be placed any where within the abdominal cavity. In ,-omc instances the cecum becomes greatly dilated, the so called Giant (,'ccum, and it may givo gastrointestinal symptoms frequently referred tt* the upjwr abdomen ami rnft/uscd with those of peptic ulcer or cholccynitiis. h ixatum <ii tin: ci-eum and right colon or hemi colectomy may be indicated- Volvulus of the n-cum may occur and is arid to cause one per cent of all the rsms of acute iriU nUnal olmtrurtion. I'romot .j 54 Association of American Railroads <*. h-t- surgical intervention is imperative fof ileocecal volvulus, an it is a very lethal condition in contrast lo vofvuli'* f lit*- m^dk'h! which may he handled more com-ervaUvviv. ileoeeenl volvulus may al-" complicate pregnancy. This con dition cao usually be diuitiiu.*ed hy roentgenograms. MLCilANKAL i`ACTONS The right colon mav ho involved m wounds, perforations, and adhesions. In twenty per rent of individual* the r<-nim and right colon have little tixation and a penetrating wound in any part of the abdomen may result in injury to this part of the bowel. Obstruction.* rau-vd by tumors, inflammatory hands or adhesion?. either |>o?toperuii\< or nUi'-rat -- in the pir^m-r of a competent ileocecal valve luay progm-- in :): a degree I:..-it itai/gren* and p. rf>r.ttn>n <>i tin* cecum mav "'a ir, tin- r> -nil ) intraliiuiinai pre>*ure M'f.flHC IXIIXTI'A'S Titberruln.i*, ainni liia.-,-, a'-U/mui 1 and r ),tiid 1< v< r rna \ ol-o mvuive (!. light -!..!, J'i,!.<rrui'r-!- ion;., ih in vt v i she inl<-*i;n.il trad in fifiv }<>.' ceiil o! all t h>- ca--* of ad v.-,m i-1 |i:dfii"Uarv dt-> ;w. Uov. .-vi-r. wild modern care ulceration of the vni-.um ami the ilium i* ralh'-r rare. Medical rare j* the treatment of choice. Amoeboid* ol tin: cecum occur.* more otten than realized. The condition may he confused wit b carciinunn. However, .\-ray otudies often make tilt diagnosis. Actinomycosis occurs in the abdominal cavity iri approxi mately twenty-live per cent of case?. It i-: usually in the terminal ileum or in the cecum. It may exist for months without symptom? other than a palpa ble tumor. It is oniv when explored surgically or a sinus develop- which pro duce.* the typical sulphur granules that one can make the diagno-is. In the past actinomyco-i- was treated with pota-ium i'idido. Now the accepted treat incut of choice i.* excision of ; much of the involved tissue us possible followed by enormous doses of fienicilim; ns heavy R5 twenty million units a dav. In days gone by, typhoid fever wa* prevalent, and jH-rforatiun of typhoid ulcers was not utwommon. It is well to remcuilwr that in twelve per cent of the perforations the ulcer was in the onim. ' j J INFLAMMATORY UJSIONS Inflammatory lesions of the cecum include diverticulitis, typhyhlis. perityphylitis, non-.-'fKieifte granuloma, cul'To-colitis. and ulcerative colitis. L>ivcrtieiihtis may involve any p irt of the intestinal tract from the esophagus to the rectosigmoid junrlioti. The <-cum is no exception. JJnerticula- in the cecum usually take the lorin o: a >-lil:irx h-ion, and a ic most oficii en< o:i:.t< re v during routine exploration. They may hveome iidi.inieii and a large mtlain- matory mass indistinguishable from carcinoma mav i>e palpable- Typhyliti-, peri-typhylitis and uuit-specihe granuloma present ns jv.a>.-r* ionmj in the right side of the abdomen for which no can.*(.- can usually be inscribed. Most often, typhylitisis cauw-d by apfwndinti.- in which the ap|*udix i* buried in the wall of the bowel. Occasionally these granulomatous masses arise through perforations of the bowel by a foreign body. Masse.* of mesenteric nodes in close proximity and secondary to ulceration within the cecum may produce a huge tumor in the richt lower Quadrant and such a tumor may be confused with carcinoma, but an experienced roentgenologist can probably make the diagnosis by recognizing the deformity to be from extrinsic pressure rather than intrinsic. The cecum is involved in twenty-live per cent of cases of ileitis i | ! j i 0f the terminal tive-colilis miu part of tbe bo certainly progr hemicolectomy Benign tumo Lipoma of the sub-cron in < corn-c!!-. di.<-utumor iii<>--t fi gruf* ita-tr<>tu: iri (hi' 11;n tlie ceeimi. bu tween pop estimated th.i Ti.< y may rv. or beyond. I no ewptiun. the cecum Wu C'urcinntnu, '5 the richt col nridinii.s }i*e. on be found, vithout expl: rhi* lesnm us rrotuherancc vail of the cec .utnors occasii iiarrhea withr malignant, bu frequently .v- 1 ArHomil involving tin hemicuioctom continuity. occasionally radical remov tive preparu state, restor use of antib Emergency postopvratix materials, a1 i -s*Msa .-***?****' 'KTW- xif/*S o it 13 a very lethal '' I'c handled more ,'nancy. This eon* *. and adhesions, -.ivo little fixation " -'lit in injury to : .minatory b mds of a i-onipelent mil i,,rmrati<Ki may :tl?o involve .i-.il tract in lift/ v>*r, with modero lical euro is the nt1- realized- riv "soften ivit> ipfovi,-nim.i) [l.-uni or . r than a palpamps which pro* .gno-is. In the -w the accepted ..-'Ue as possible . minion uhi(d a :fimi ut tvphoid ive per cent oi a.i m. Di- ........... pi . gus to i > U'-.i: in ; in> -i Hi -i-iaU-rr-l i ' oge md.m Tv phvhnx, i.-ium in the .-rib.-d. Most mined in the rifi.'O through .--ric nodes ta . iv produce a .V t.. VMlllV.Attd a>iv make the n *se- rather :xo tu Benign tumors oi the ei.-vum inviudv lipoma, l.-iomyoma, polyps and other?. I.i(Kinia <>i the -itm-tum-* r- i -in- gr>-st -im. It may be -nl.mucous <>r -ah.sjrous in diameter. and i-* oiii-u .m-fukin ior a malignancy. Whenever correctly dingfc'eil. it m be ........ti"l nr .mn-i.-ated, f.eiomvima is a benign tumor ::i'ct In-qicri'iv looii'l In ')n` lumadi. It u-inlly Uiamn-ls il-ill hy gross gastromte.-unui )< morrhage, tin: r>-~ilt. ol' ulceration. It is rareiy iound in the <-o<:um where n-rr-tum b usually carried out. i'olyps involve not only the cecum, hut all other poriems of the intestinal tract. The relationship be tween polyps and cancer, particularly of the colon, is recognized. It has been estimated that severity-live per cent of all cancers oi the colon arise in polyps. They may exist at any age, but they are most frequently found in middle iife or beyond. Polvps should be removed as they are found, and the cecum is no exception. However, it i.-i very difficult to make a diagnosis of a polyp of the cecum before it has become malignant. M Vl.lDN \.vr n Minis (' iri inoma, carcinoid and r'-onia am the mo-t fmpi>:nt maugnaut tumors of the rigid colon in that order. ir'-ui'iiia of *.hu right colon is u-ually a wry insidious diseuse Any patient who Las proimuid an'-mia for which no cause can lie found, who i-* lo.-ing weight for no known reason nr who i< 'imply 'iok without explanation, is to bo susperi. d of having carcinoma of the right colon. This ledon U.suaiiy exists us a large, liar, bulky type of growth covered with protuberances that look very much me gr-imiiaiam M--ue. The norm,illy rinn wall of the cecum rapidlv 'oorix-s and Jo conn a is vrv pronouno-l. (' ireiimid "imof s oeca.'ion illy : u < be uui md mu-t uv.--* p-i id... mints- u-table ii.irrhca wiinout -ding, t'. rcin-id tumm- are -up;.... d to rath-T mu :l\ M.'iiign.mt, but th" do i .itt in- ..-id >-m-e i'-.-it h. I.i mmm-.ire'.ma is n;,,.i fr- 'i'i'-ntiv --eii in tie- -i-madi. m i :r :;, i- vry w.-;) m -urg:e:d ew-i'-n. It ilso oei-'irs m the eeniin. fie- ui igrio-is can U'uallv bo m ide by X-ray -tudics and treatment be -iirger;.- or \-ra-. - h often -Ui-faetory. ro\IMi:.\T Kxcisional therapv is the t rcatment of choice for most pathological conditions involving tin; cecum and right colon. It often can be earned out as a one stage hemicolectomy with end-to-cud or xdc-to--Mu reconstruction of the bowel continuity. Diversionary procedures such is ilio-transverse colostomy may occasionally be indicated as definitive procedures or as the first stage of a more radical removal; when the patient's condition warrants. Thorough preopera tive preparation is mandatory in ail elective cases. Correction of the anemic state, restoration of blood volume, thud and elccfrnlyrn leikuun, the vigorous iisn or antibiotics and careful mern.amcnl eleansing ,] tho colon injure succesa. Kincrgency cases can be greatlv sate-guarded bv massive nntjbintie therapy po.sto|M:ratively. The tv'tsi >;l iru-i-ion, method of aiiaslomosia, choice, of suture materials, axe mattera of choice for the individual surgeon and are secondary 66 Asfociahon of American Railroad* id importance to observing the well-founded surgical principle* of perfect hemostasia, geuileness, protection against soiling, attaching healthy bowel to healthy bowel, and proper evaluation of the patient's capacity for recovery. (Applause) ,-e<. & ^se unernployabl ill. These people sponsibility and of there are the obli k;* Dr. I. Goldowbky: Thank you ver>' much. Dr. QuatUebaum. /ryk employer. Too Usually at home, at meetings that I attend, l never know in the discussion emotions are allot period who talks longer, the surgeons or the internists. Being an internist, placement of thea myself, I am going to av the surgeons talk longer. I am goiDg to try and keep . difficult to render this railroad on time here today. 1 am going to take my prerogative again of limiting the discussion to three minutes per person. So, if you hear the gavel bang, you know you have to got off the lloor. Is there any di-cus.-ion now of Dr. (Tjuulebnum's pajxT? Wo must- have pyme surpeoiis here. 1 km>w you arc ;.ii in,: internists. Any disu Dr Kelson. The American job placement ao cukics find to ad legal exports find such questions as altered detriment Knowing that J in. JIahvKV .N Ui..son : I would lib to ;,-k 1 >r (,'uaUU.h.ium what type of antibiotic- he .> j>t< [.r.u*\clv. V > have been limiting ourselves to Ncoji,\ i m I*.* i.!!_> (our hoiii - ! forehand people, the ijuadvisable for a j with heart disc* Thu problems a Du. Qr,\Tn.>:u\i \t, tin- lb*e<rd > carefully induT and work for Di!. 1. G0LOOU6KV: Is there any other discussion? if not, again I want to thank you, Dr. Quaulebuucn, for a very fine and interesting paper. We will go on with an address that I know is going to create discussion. I don't think U is going to be di.-eussioii. I know i U going to Ik.* art argument. I haven't even heard the uddn.-- \ei The Hole of Tr:un,.i in Cardiac Di-i-ax- hy Dr. (. D. Burch, who is Head and I'roit--sor of liu* Department of Medicine, Tulnnc University School of Medicine; Physician anil Chief, Tuhme University, Chanty Hospital of l.imitmwta: Visit im; Physician, Tnurro Infirmary; Consulting in Internal Medicine and Cuidiology, Hotel Dieu: Veteran's Administration and Illinois Central Hospital Dr Burch. (Applause; physician. A and his advice especially when gradual, contwu works hard or especially if Uw often inferred joh that cxcrci sicians place it i aanimed considered iae< will not aggra pecially,*do n< which justify Db. G. E. Bcstcn (Ocbsner Foundation, New Orleans. Louisiana!: Mr. Chairman, Gentlemen: The relationship of employment to heart dines**** js ho extensive that only selected aspects can be prc.-inied. With the increasing life span *>t man the numlier oi people with cardiovascular ritsem-- increases. This in:v> be related to <),nmol,-me mom:, wear ami te.ir of life proves--****, ac cumulated inpiry, as.d deui-m-ration *,i complicate,1 metabolic pmces-cv There bn- been ruii'id'-rahle mi'-n-: m in.- * ] j * *) - ,.1 sire-.,- nod tram ,,i, t)nneart tn,m tin- Maod|i-,uii <| pi* ventivc n.e-bemc and therepy as well iia job placement. i'mni his beginning on earth man h/u* l*ecn mibjected to stn ss nod strain or wear and tear. Furthermore, he will never Ik: entirely free from physio*I and psychic trauma, whether in* develops heart disease as & result of it or not. With this realization man must be given advice in his choice of work and in his rare during periods of acute, chrome or irreversible dines**, in an at tempt to preserve hi health. With the recent rapid growth m industry, there developed a period of manjxjwer shortage which brought ai>out the employment of a number of other- Fortunately eynipionts. evaluates the difficulties pr< work ami liv bitus may h*. warnings, and its pccu eiciau when with Ids heart calculated risi as he contend are not worse The person toms will pern cuity. The r-'iax" , y --**V'.T' - > Jf*--1'*o* w iiiles of perfect .ilthy bowel to (or recovery. .71. -i the discussion no internist, : o t r>* and keep --.alive again of i hear the gavel We must hive ,;n what tyf-c of irselves to NVo- t very . ami :e discussion. I c an argument. h, who is Head -rsity .'School of .ty Hospital of :;ig in Internal i<*n -uid Illinois i.-aii.u: Mr alt <ji '.L-e I- --I i the mrn.-u.iuig -.-e-.we mrt'M.-1'j. i-i 1'roci-j.aes, actAjlic processes. vl strain on the v as w.-ll as job ou to -tress and ureiy free from ,e as a result of s choice of work illness, in an at- . (rt.-ri<Kl of man* jnio" of other- Proeredin/i* of Method <irui Snrqunl Scdion r>7 wi.se unemployable, ill people, of whom many with actively and irreversibly ill. These jx.*oplc were a continuous, serious health risk un<i became a resjiontjibility and often a burden to the cmuluycr and labor groups. Of cour-'e. there are the obligations of management ami labor to nn employe who has become irreversibly ili after many years of faithful and effective .service to his employer. Too often, to the detriment of the employe and or the employer, emotions are allowed to enter into deiudoin c<>t\c;nng uinplovabilit.y and joltplacement of these ja.-ople. liven with strict adherence to clinical data, it m difHcuit to render a satisfactory decision. The American Heart Association and its aifiiiates have been interested in job placement mid rehabilitation. Th -y have aiu-mpted 'o U-fi;.< the ultics anil ro advi-v the -mployer and -mploye properly, Kv.-n ihe medico legal experts find it ditlieuit 'o reaeh po-ci-c, fair and satisfaetorv answers to 'I|eh questions as: W -,s tin: hi ilth of the inplnM; .icgravtilcd, ai'er-l.-rated or altered detrimentally in any way durum the roiir-e of his work? Knowing that cxcreiso is beneficial for --very healthy person and many ill people, the question remains: IIoiv shall we deline what is satisfactory ami advisable for a particular person? It is not possible to generalize for everyone with heart disease and still do justice to each person with cardiovascular illness. The problems are complicated and the variables many. Each person must be carefully individualized. The outlining of graded, properly planned exercise and work for each particular patient should be the responsibility of the physician. A good physician always docs that which is best for bis patient and his advice must vary to meet the needs of each person. Sudden exertion, especially when .sustained and extreme, is probably more detriim-nr.il 'ban gradual, continuous exertion. Ao older person who is sedentary all week and works hard or plays vigorously on a weekend may develop serious uiifieuity, especially if there is underlying cardiovascular disease. However, it i9 too often inferred for convenience in arguments and decisions concerning a man's job that exercise is dangerous for anyone with heart disease, because phy sicians place patieaU with heart disease in bed for prolonged periods of time, it is assumed by many that any oxerri-e aggravates cardiac disease. It is considered inconsistent to state in a specitic case that a man's work did not nor i will not aggravate iris cardiac -late and precipitate death, f.uy people, es pecially, do not underhand tin.* phy.-iologii il -itii.iiion.-i nor die eir'Um.stniirc-* which ju.itu'y such variations in opinions. Fortunately, many patten's with h-art <i;.-.m.-c arc well protected by their .symptoms. If 'lie pic.-.ici.m . .in-i'nllv ami mi-iuuinu -ly .-heirs and pr-i|M-rlv evaluates the symptoms pm.-nU'd, most people can h protected from -erious iilheulties produced by overexertiou and psychic disturbances associated with work and living. However, inadequate consideration ol cardiovascular ,-ymptotns may lead to senous tliiGcultiea in spile of the subtle, naturally provided warnings. Cntil the patient learns a great deal about his particular disea.se and its peculiarities of behavior, he should be instructed to contact l-.is phy sician when in doubt about symptoms. He must learn how to live and work with his heart disease without precipitating difficulties. To be sure, certain calculated risks are frequently taken by a person with serious heart di.ease, as he cootends with his environment and with his job, but most of these risks are not worse than those encountered at home. l The persoQ with cardiovascular disease should do no inoro thau his symp toms will permit. He should not test himself until lie develops serious diffi culty. The man with angina pectoris should do nothing that precipitates pam, !A "ri tors that initate ports events as io often ilisturbal exertion, are tot .-vx-uine that ix." This must nan phy.-iiolony. iilt'rution in job Ixvilth ruu>i he oil- *1111v after i mu. I'hi- -.-irly h. t`T/, tfiU* i job pluriunutit it a'-i-nti-nt. A i.vt act: likely to >i the -tress, the ,?s AtU produce t. Wtieu these xinties and the -nnor;, aueh a i-aui 'ate "ii-i.U-. re- ri'. ..-I- vnij dl- i.'uiu.H une. A Ky'.ricni.-e with ienis, i-tiuld be el t :;t* t Ue of i i-iiruiiii;auy ill r-ix-i-tive, they ;e employment - "-it t Hus -.1 -.itl'l.-v- --,.ust --U -.'itli :;!' < 'l. a-s A. d ax > ill 11.19 mure In- |>iiv-i. i:in ni proper to to impure ureiul clinical merest of his to his patient. Vh<-n a man is donut of his . i.c should he d-s develop ;-cvuluate his d not to hide tor lo- \t t I 4 i t i i ( } i t Praccctiings of Medical and Surgical Section 39 the same time, however, it is necessary that the physician be careful always to advise his patient without producing an anxiety state. Labor and management must cooperate to ensure proper job placement. Labor and industrial organizations should provide jobs for the chronically ill. Job facilities and opportunities need to be studied by both labor and manage ment in an effort to help the ill. Physicians working with industry and medical organizations, such as the American Heart Association, need to study further the effects of juhs upon workmen with cardiovascular lesions. Rrmt-mi'i-r, a person without work often is under greater stress and strain than one who in r.-l ixcd at work. It is far .-a-ier to control physical exertion than it is in i-.mird mental tre-sor psychological disturbances. A ui.ui ran, on advice, r*-iroii irum pb\ u-nl a.-rivilv, bul it i.soften very difficult. for him nut to v.uitv or !,e o-.i-iiv anxioiia i-vi-n wtnui lying itl bed. Also, remember, a foreman .-itiing at his dc.-k worrving over problems frequently expends more e;U*ocfl and works more >trcritiouslv than the inaa tvlui is sitting at a lathe jjcacrfully working with a .-implo routine procedure (1). Tbe environment u.-df. mav produce cardiovascular stress. We have shown that hot and humid environments increase cardiac output (2, 3. 4). At high temperatures and humidity (UG'5 F. and 73% relative humidity) cardiac work can be increased several fold. The effect i3 leas at lower temperatures. Patients with cardiac, disease may develop acute congestive heart failure when placed iu a hot and humid environment. A cool and comfortable atmosphere is Ies5 distre--mg. The itiffuem-e of irm|vr.itnre and humidity is dependent primarily upon il,* r ile >>t ih*Tm:il lu.s ami tin.- rate of heat production, or the accii for beat loss in order to maintain thermal balance. Exercise increases 'he rate of Iwat ofoduetiim and, Uu-r.-iorc, m-fesMtatcs a lower eovirorunentai temperature rir>d humidity to maintain a ulfick-iit rate of heat lost. The heat hvui is lv?3 when the p.-r-oQ is at rest. Air-conditioning during the warm months can be extremely b.-n'ijri.ii in ensuring rapid and satisfactory Vates of -.at *.*. I'.itieiit.x with .-logina pectoris or impaired cardiac reserve should not .-. ..rk .ircmiuo-ly in :i hoi ,iu-i humid envirunir.c.'it. .Vs staled above. -udde-n strenuous exertion is much more distressful than ..ild exerdon "f rr: -n -},!. ii : g:in ill. ii;rr<\(i>d. This is not oniv n.K. : .r amu wi-h ;:<- -. r>u? d-o - r 't-i; ..Id or too p> r un with c. j;.,r n!;:..-*. < e-b-r '-pic i-'in d., .tii-. = fiiug 11, it y.ling people can .io ih-.vi-l -o!i -ic.-i'.'i.ii'1 in i hi. fi i-i do if. i" 'i\-in w,"h h-..rt li i.-e. iike- ii.-v'.t fa- in a fiuirv . r n /.m,g j ifiguing hours <*f auric .-Imuld .ivui.j.-d, ind iiifeeiiniH, ii.i-ludiirg it,e e,,ininuii cold, .-hciitd be treated pruOif>!v with <(!>|>h. is ><n r. -i. The value of lie: |x-ri..dic or ii.llow-ep |;i.;dlh examinations of employs with rardiac disease cannot be over-emphasized. The employer would bo wise to make stire that at least all iil employes arc carefully examined periodically. Tim {vuii.-nts uith largo le-.irli -in; liie most vulnerable amt tiavc the. worse prognoses, i.c., the larger the heart, the wor.-e the prognosis, all else being equal. A man with a large heart, a gallop rhythm and a tendency to the aa* aociatcd low pulse pressure which usually exists <a low systolic pressure and elevated di.-i.xtoiic pressure), is seriously ill, Such a person should not work and usually is not able to work. Certainly, the person with obvious con gestive heart failure ehould not work. A person with angina pectoris who knows his limitation and restrictions and heeds them can usually get aloog extremely well at work. Oq the other hand, the man who has anginal pain that is easily and frequently precipitated is a poor risk at work. Persons with certain oon*fatal cardiac irregularities are poor work-risks n "Stokce:% and high -r. or from ic persists utiy uvalu:i to cease ofarct the . man may type T aval d.,ta ram r>u.t .ruiogr.-im :,l nc not. i electro- .art was -roblems; numaoly ;'.CQt and patient .it i W* r-p.itJ* .uice as itienc*, vriology Humid a and in ..fi'-an . . nine it ..I 1.. ft . . Ifcarl Grad, oiput, ting in r that . iloor. , h we : rector ui try d. Procee/iinqs of Stedicnl owl .'vupjicaf Section 61 WEDNESDAY MORNING SESSION M irni 1 "Vi8 ' The Wednesday Morning Session oi the Thirty-Eighth Annual .Meeting, Medical unci Surgical Section, Association of American Railroads, convened in the EJgewatcr Gulf Hot*-!, fMi'vwrtter Park, Mississippi, at nine o'clock, A. M.f Dr. I. Goldowsky, Chairman, presiding. Dn. I. 0< 'i.nowsKV. Cicnth-mcn, I >.m going ro get on with the meeting because we invr some additional ci-nt.-nt to .,ur ini' thi.s morning that is not marked in your program. We have with us the men from '.he Railroad Retirement Hoard who are going to give us a talk later: To K.y-p Experience at Work which has to do with the present stabilization of oinplovment. So, if you will bear with us and bear with them, we will go on with the pro- gram. Now, at this time it gives mo a great deal { pleasure to kick myself out of office, and l want to induct our new Chairman into the office the first thing this morning. Will Dr. Bennett and Dr. Olson escort Dr. Stockwell up to the the front. (Applause) Du. IV W. Stock wbm: Th.mk you. gentlemen. 1 >i!. I. < ;./i.ii'i'v<ky: Dr. Hmi, u i- a pie -nre f..r me to turn over ThD gavel to you m Mart to break y<m into the h-nl-iehe of thin job. There are not too man" headurjjes Pwiu.-c l atn ur that v>>u will have the same co-operation that f have hail tin* past year oi every member of the Section and all your Committee Chairmen. So, without making any more .-peeehe*, the job t yours. ' Du, H. \V. SrocKweu.: Thank you vry t/ui<h. Dr. CoMnw-vky, ami memhers of the Medical and Surgical S- et:.n: It i.i indeed .m honor to be .-le- f.-d ' our Chairman, -n-i 1 rtainiv do j>(ir.-eiafe, it. f think, ilr-t. wo -honld rMnmoit m *he a ay that Dr. < ioldo-.v-ky ha* bandied things during the p.i-t. af. !!> I,as bom an evretl-nt * i,airman. Ife has d-mu a lot of hard aoik, and he has iccuiuph.-livd many things. He should definitely he complimented on the performance of a job well done. (Applause) This year the Committee of Direction will meet for the first time sometime in the summer, and the various standing committees will be appointed at that time. The committees, an you are all aware, do the work of the Section. As soon ns the appointments are nmde, we will try to get a news letter out to all of the members of the .Section :w to who they are and what to expect. I Uiink-it would be well, if we ran, to let von know during the year what is going on instead of having that knowledge ctueily in the minds uf the members of the Committee of Direction only. As said, it is an honor and they tell me that there is some work connected with it. I certainly hope that I can do half as good a job as Dr. Goldoweky. If any of you during the year have any question* concerning the operation of Ihc .Section or have any irrgge.ilioni-concerning our program fur next year, we would welcome very much hearing from any of you at any time. Thank you very much. (Applause) U ' ' V7 .-..-^c'..- <. ,W--?:%":' : ..*: *- Ar^Ligrdl-^ y^iwAfer rVk 62 Association of Amencan Railroads Sow, Dr. Goldowsky said that lie wa relinquishing his job. I don't quit agree with that. This is still the meeting that was arranged by our ex-Chairman. 1 think that it is only fitting that he continue on until we are through here at Edgewater Park this year. So, Dr. Goldowsky, you didn't get out of the job. I will give you your gavel back for the rest of the day. (Applause) Dn. Goldowsky: Our first committee report, and our most important committee this morning, is our Mcdieal-I.cg.il Research Committee; and our good Chairman, Dr. Mishlcr, Chief Surgeon, Erie Railroad, Cleveland, Ohio, will u-i', you a lntic about what ha-!>''. n going on the past year. .a?. j5Si m *A jf ;&< Dft. W. E. MisitLnn; The Mi-dired-Regal Committer which was appointed during the past year i- r::r> up of f 'r-. ]J. .!. Bcum-tt, Chief Surgc-on, 1). J. < F. R>v, Harvey Net- i, Chief Surgeon, Son bine, and mvmlf; also, Messrs. Ewing. ' !<(,< rai <'!. u . A 1' h: -'ii. 1 i..i ,y >a!.l;i I . It. K *lv, ( i* ner.il ( tn.,rj,ee Ml 11,. < ..... ..... .Vtttr.ve.-|ern R.uiw.iy; and H. K. Minor, Genera! t ).in,i Ag< lit : Jlhhoi- t entral. Two n'i ring' have l>-< lieM. While the Commit I w- did not have u spenfic aim nr pur (msc a hen it wa- formed, it war intended to aid and jurist, if possible, the solution of some of the problem? niferting railroad* that arc common to both department-. As our first project, it was felt that the Impartial Medical Plan as adopted at New York and Baltimore had merit. H possible, its adoption in other centers would be advantageous. The principal charactcri-tie? of the Xew York plan for those who are un familiar with it arc: fl; Tie- fees of the impartial medical experts were originally paid by u foundation, but later on u showing of economies effected by the Plan, those fc-'S were and are being paid by public funds; (2) The panel of Medical Exjx-Tts were set up by Jural medir-ai societies with a numtK'f of doctors ap pointed to the various specialties that were considered appropriate. A list of these experts were kept comiuemi.il and were selected iu rotation aud without prior knowledge of their identity by the court or counsel. Only senior experts were selected, and usually they were men who do not make a practice of testi fying for either plaintiff or defendant; (3) Coses Which were to be submitted to the impartial medical experts are determined b# flic trial judges on his own motion or at the suggestion of either party and usually at the time of the pre* trial hearing. The judge determine? whirl: specialty or specialties are required in the particular c.ii - b-h.p- him; i I \VL< n a ca.-e ia selected for expert hand ling. the clerk rietenaim- tn>m a c'-mi'i'-Mirtl li-t the expert next in order and the >i < i my required ami make- ;dl arrange ment* L'-ee-.-arv for the cxaininati'jn lv the doctor: 'a - Tim expert in every instance w given a free hand to make a physical examination and make all laboratory tests and take all X-rays he feels nm-s-ary. He is also furnished with the reports of the doctors employed by the parties and results oi lulxjrntory tests. X-rays and hospital records, if any; (6/ After examination, the expert witness makes his report to the court and copies are furiii-hed to both parties; (7) At the trial the expert may be called by the court or ciilur party, and his examination i.- conducted in the same manner as any other expert except that the party called is usually not considered bound by the testimony; and the impanial appointment of compensation expert is made clear to the jury. At our meeting it w.is suggested that .Minneapolis and Pittsburgh were center* to be considered. &$# I migt help fron Camey h He rep *r Med Alley not t Med of t* whe: "I Ivm Mm. to g>. MV npprprov: "I is tin "T favc-: a pi- "T taw : enou havi "I burg an v. mat. spoi oth* All.-Di' inn plui: favc Hr jr, r : i.jcr'i't'T'* .'-u' -t/r, lon't quite .'^-L'hrxir- .. through you your important and our .cl. Ohio, !;..;. & >, Messrs. Gemini it. Minor, a specific .: possible, ,mmon to i iu .o arc unoriginally the Plao, t Medical . .ctors .ipA 10c <>i .a wuhout r ti.'-r'H l-'OlU'.tu'l >: o.vn ' 'ho pre* : ri-i|uiri'*l . ff 1. *mlr<ior ami r the <-x* i tree hand i take a\l :,t> doctors ,-i hospital i report to ue expert conducted t is usually utment of urgb `'lire Proce&iinqt af .\{e4icalanHSuroxcnl .Section 63 I might say here at this point that this committee has had immeasurable help from Mr. Ken Carney ami his ihi.-varch Bureau. I might say that Ken Carney has done most of the leg work for this committee. He reports as follows as relative to Pittsburgh: "Pursuant to the understanding we had at the la.it meeting of the MedicaUr.cgftl Committee, 1 h ive gone into the situation at Pittsburgh, Allegheny County, Pennsylvania, uirh a view of determining whether or not there would bo suiheic nt menst in the ii..ritijfiin of the Impartial Mediva) Tuiiirnonv ('I.iii n.l :>.* n:g g.-ncrnlv 'in- one in New Vork. " first of all, [ have had a meting of tin- heads of the Haim departments >>f the various railroad? "periling in Pilt.-.burgh, ami found an over whelming sentiment in favor ol the plan. "In addition, I also learned two outM.uiding orthopedic men, Dr*. Kenig and M&zoni, had already started to got a resolution through the medical society for the adoption of such a plan. "It was also learned that Federal Judge Gurley had been in favor of some plan to provide impartial medical testimony. "At the suggestion of Mr. Peter G. Edward, I talked to Drs. Kenig and Mnzoni and found they were tinder the impression it would be necessary to go to the legislature for relief fur adoption <*i .-uch a plan. "Wo further understood the m.tttor hud not boon progressed to any appreciable degree, would probable hog ,l<>an unless some stimulation is provided. "Dr. David Ca.ss of the Century Building, Pittsburgh, Pennsylvania, is the current President of the Medical Society and general claims agent. "The Allegheny Bar Association aottld, in our judgment, respond favorably to requests from rho mcdi.-il ,, i.-ry to jointly -ponsor such a plan. | "Tic* unetit ami iiwuniii.g p:>-udm,- -.re b"ih m.-ird.i is ..f t .) -h-nsc , law tirtn. how-vor, u.d might lm but I b.-iieve 'h<io aoiiM be >'i."iigh iiiiimuicc brought t., b ar u-r -uch a ; ) .n >h it v.<- wnuM pr"bYr>lv ii no r- a) 'rouble wiMi the Bar a a hole. "[ have not proceed*?! b'-v.iiid tins point a.i it imw apjiean that Pitts burgh would provide a lihHv placet >< adopt 'he plan, ami if handled in an intelligent manner, would likely he adopted. "All those interviewed in this matter are pledged to secrecy as it was : marie known to them that any knowledge that we were interested in | sponsoring such a plan would do more to defeat its acceptance than any , other single factor. ! "My attention was called to the fact the real need of the railroads in i Allegheny County in connection with a plan of this kind is in the Federal District Court, and that the court probably has no Minds available to put into operation such a plan unless the ro.itu were nw?.i'i| against luith thu plaintiff and defendant on a tifty-tjfty basM t< avoid any tendency towards favoritism toward the piaiotitf or defendant. _ "III can be of further service to you or your committee in this matter, I trust you will advise me of your wishes." Ii t ) 1 vx 64 Association of American Railroads W s*;' fy I have & communication here to Dr. Nelson by the law department of the As i.V Soo Line: of hei "Dear Dr. Nebson; wewc `'Enclosed is a copy of the resolution adopted by the American Bar Association relative to the Impartial Testimony and also a letter from the Bar Association in response to a letter of rrune inquiring about what Ho I wan useful activity had been undertaken to expedite the adoption of such a plan. "After you read the same, return the same to me." The resolution adopted by the American liar Association is as follows: "RESOLVED that thv- American liar Association adopt a national program to be implemented at the local level for fostering the creation of panels of in.partial medical experts under court aegis in the pre-trial con sideration ui.ii trial of pcrson.il injury cases, especially in those communi ties where there is a voimi).- of pcr-oiial-iujury litigation in the court and where th re is Mtshn.-iil number or qunijiied dovi<,r. .available to con-mute a par.ri: tin: pam-i l<e > J,, tc.j by proicssiotml bodies on the basis of professional 'iiialilioatiotis; that the panel be employed in the pn-trial ami trial Mag'- of such c:w ami that the copies of this resolution together with the attached report of the Section's Committee on Impartial Medical testimony dated August, 1956, lie forwarded to all state and local bar associations represented in the House of Delegates with the recommends- dation that this program be adopted." Vs. IiDocto atony wornthe 1 "In;; York. I ga much new,: Nc say a plain K< The Section on Publications aiui Services of the American Bar Association wrote to Mr. Beckman of the Soo Line as follows: M "This acknowledges vour letter of March 5th with regard to the report I of the Committee of Impartial Medical Testimony. This report contained a resolution ou the subject which was presented as amended upon recom hold mendation of the Board of Governors to the House of Delegates and It adopted by the House. "We enclose the attached," which I just read. "You wiil note copies of resolutions together with the report of the Dr. committee before to all state, local bar associations represented in the Aj Housed Delegates with a recommendation that this program be adopted. of' This has been done, is gc "The State Bar Associations of the States you mentioned, Illinois, mitt Wisconsin, Michigan, Minnesota and Xonb Dakota were included. We We were unabie i<> toil you what committees of these associations were con A tacted; nor, are we abie to tdi you whether the election of Judicial Ad D ministration has received word frmrt any of those organisations. Tins olheo h.'i.s Mill. "We nre sending u copy of tin.- Idler to Justice Clark of the Supreme I thi Court, Washington, D. C., who is Cl.airman of the Section," in w That handles Minnesota. Shortly before this meeting, another member of this committee has con tacted the federal judges of another di.Htrict other than Mimtc-ua or Pitts burgh on thv nn-ril.- of this piaii, and it i- itntwtpalvd that u niciing of them which i* to be held fcbortlv will be fruitful in the adoption of uch a plan. The say a be I the At the last Committee of Direction meeting--and this i changing the sub ject--the I'enuaylvania Kailroad proposed to the A.A.It. a study of the prob lem of the clTrv}*. oi di.-scl find in l.a-mnritivv cab- and in shop*. The subject has been referred to this coinuutU-e, also. However, nothing has been done to date. are I WM -' r v department of the .* the American Bar .1*0 a letter from the :uiring about what i of such apian. , is as follows: 'i adopt a national ring tho creation of m the pre-trial con in those ournnumioji in the court and uJabie to constitute ties on the basis of red io the pre-trial 3 resolution together n Impartial Medical ~tate sod local bar q tb* "'commenda- <.ao b isociation regard to the report .`Ms report contained needed upon recom.e of Delegates and h the p-port of the i represented io the llij l>! pted. "A'Uti'Ui'-d, Illinois, .. .,! i.idnl. We w.c-oni>f Judicial Ad* iff/riH. This '.i/k oj the Supreme lion." :ommittee has con* Minnesota or Pitta* t a meeting of them i such a plan, is changing the suba study of the prob!iop. The subject :ning boa boen done Proceedings of Medical ami Surgical Section 65 As I mentioned before, Mr. Carney baa given this committee a great deal of help, and I hope be will continue to do so because without him I don't think we would get very far. However, in conclusion, in spite of the fact we have only had two meetings, I want to say that this committee in my mind is going to be A very active, useful and busy one. Thank you. (Applause) Dr. I. Gqldowskt: Thank you, Dr. Mishler. I just wanted to bring some of the men up to date. If they didn't know wbac Doctor was talking about when he talked about the impartial Medical Tosti* I mony, there is an Impartial Medical I'an.d in the City of .New York. The works navo been published, and those that nre interested in getting some of the basic facts about tlua, [ would refer to tho title of the book which is: "Impartial Medical Testimony," published by McMillan and Company, New York. I gave you the basic book. I think it is well worth reading. I think there is much which could be changed in it which would be of benefit. Like everything new, it is only unproved by aging. Now, if you will bear with me, I am going to ask Ken Carney if he wants to say a few words on this. Ken has doac all the leg work. As Dr. Mishler ex plained to you, he has been the eogine and spark plug in this. Ken, would you want to say anything oq this? Mr. K. A. Carnet: I doa't think l have auytliiug to mid, Mr. Chairman. I think it is a very vital committee. I tbiuk they are going to make real progress. I am tickled to death with the way all of the doctors have takeo hold of it. It looks good to us right now. ,v Dr. I. Goldowskt: The legal group has named their own chairman; and Dr. Mishler is our Chairman from this section. Are there any of you gentlemen who have any problems you thiuk not only | of interest locally, your o-e:i road, or ,-omc neighboring road, that you know 1 is going to aiFe-ct us nationally that needs sonic research, give it to the Coni* mitUa) of Direction: Men ."Uo<.!;,.vell your new Chairman; or to Frank Parker. \V'*e will put it in 'I./: proper hands. Are there any other qui.-.itious on this, or is there any other discussion? Dr. Nelson. j Dr. Harvey Neuso.v: Dr. Mishler roentioneJ K'ermit Johnsoa'a letter. ! I think we are going to have to coutcud with a certain amount of complaroacy < in which many are willing to accept our medical situation as it is. The thing that I would like to urge is that this is At least half, and I would aay more than half, a doctor's problem, a matter of cleaning house, of getting' a better type of medical testimony. I don't agree with Kermit Johnson at all on several points as I indicated in the letter to our group. This Medical Ethics Committee that we have in :C;` Minnesota has functioned but it hasn't had any teeth. Some things have beeo going on that those of us who are in the practice of medicine in Minnesota are ashamed of. -v,/s l doo't know if it baa been quite made clear to the group here just exactly .y what this plan consists of. The thinking is that the state societies or the local r. An*. " >V' M.IV T^.'V-y r V" Auodation of American Railroad* societies will select panels in the various specialties. These panels are to be kept secret as far as the court is concerned. The Impartial Medical Testimony expert will be selected id rotatiou so the court will not have jurisdiction as to whom La going to be the one that is to be selected. Obviously, with such a plan, we are going to have much better type of testimony. We are going to have men who are going to in as neutrals and be willing to spend their time sod effort in making an examination. And, a lot of our cases are going to be settled before they ever come to court. I would like to quote four results of the New York Plan that Mr. Ewing has mentioned. The project has improved the process of obtaining medical facts in litigation cases. It has helfKid to relieve court congestion. I think it has l>ecn shown that ninny of the cases in the pre-trial period are settled because of a neutral medical opinion, it has had a wholesome prophylactic effect upon the presentation of medical testimony in court. The modest cxjwmlituie in volved lei* effected a lurg-- Having in court costs by reducing tin1 number of cases coming to trial. It hus pointed the way to bettor diagnosis in the hold of traumatic medicine. Doctors with eminent, qualifications who were unwilling to testify before, willingly served on the panel of Impartial Medical Experts. We know that this plan cau be put in effect. The attorneys themselves have recognized the problem by passing a ruling which apparently they are to a large extent ignoring. We have a very enthusiastic committee, and we may be asking for some help from some of you in different localities. We feel, and I think I am correct in this, that the Federal courts even now have the power of appointing impartial medical experts. From there on it may get into the district courts. I am not in favor of dropping the matter in Minnesota. I think we have the same problem there us we have everywhere else. 1 thiok merely because we have some of our plaintiffs' men on certain committees is not a reason for droppiog this thing at all. Dr. I. Goldowskt: Carter. Dr. White: Union-Pacific. Mr. Chairmau: We hud in Utah a number of years ago a plan that worked very well in helping to tone down some of this testimony that was coming from doctors, you know, adverse to facts and things that we think are not right. Under the Medical F.tUics Committee of the State Medical Association, they had a very aggressive group of doctors of about 6ix who made it their practice to attend the court sessions when mcdic.il testimony was given in liability cases Smeii on physical or mental problems. When the doctors that were giving this testimony .-aw tin- group of fix prominent doctors from the state society utting then- in tin- fruit rmv of th<- court to hear them give their testi mony, it hud u very salutary effect, ami the vicious type of testimony which had been the practice was practically eliminatedNow, our committee wouldn't hesitate to travel throughout the state and attend these things where major trials were being held. They had people who were willing to give their time, and people who were members of the Associa tion such as this and in other industrial practices as mernberd or that committee. They just eat in the front row. and the doctor then going to give the testimony toned down very much what be might have to say. * Da. 1 I can and as Plan, a pebble . I am (Ann Dr. I but Dr. Chairm. elected He things t for <ibr. tviihdr.i of Diri cho-fii N.m to hilt-- Mn. i Da. 1 to go or Winl. We h: and Trr. Surgcrv Dr. C Da- S First this nic because Unfa: differen You to be & thing ft' and cot appron. One It in, p. leoge t< With Muff mi in the one per jug sou Coar that ac ment o mels are to be v.al Testimony u<diction as to otter type of ;n as neutrals : nation. And, / court. Ir. Ewing has : medical facts : think it has i d because of a: oiled upon potidjture inae number of m the livid of sti/y before, s themselves atly they are for'. Ip an cot in .ng impartial :<S. mk we have rely because i reason for ,::at worked usiing (mm - rrgl.t. ration, t&ey ,vir practice ,n liability t that were m tho state : their tosti.:ooy which *tauj and ncople who io A.i.sooia* ucnmittee. testimony ' : | I j , Proceeding of Medical and Surgical Scdwn 67 Dr. I. Gotoow.sjcr: Thank you very much. I cao tell you for sure this committee and Mr. Carney have studied fully, and as part of the program not only the New Vork Plan, but the Baltimore Plan, and also the Utah Plan, as each has its kinks, but we are throwing a pebble into the calm lake, aud hoping the ripples spread. I sm going to just make two more announcements. (Announcements.) Dn. I. Dom>oiv-ky: Now, 'In: ni*xt is not in tin; nature of any apology, but J)r. (.'la;, ton iris go/io. I imigun* ym ill know that he was our ViceChairman la.it year. Mnvbo -ome ,f you have- wondered why he has not been Ic-t.-d t 'I,.airman i<,r il.i< eii-ifing ;,c.ir. lb- i'.vi n<iiiiiiiarid !<,r >ln- p<>-iri<irr, however, Dr. (`hu ton homii-eof pressing things that he knows .are coining up and f.-rling hn would not have the time for annul live or >ix inomhs felt that it was his duty and it was his desire to withdraw his name from nomination as Chairman. As such, the Committee of Direction had to look around for a new Chairman, and Dr. Stockwell was chosen. Now, tor our next part of the program, it gives me a great deal of pleasure to introduce a world-famed physician, I should say surgeon. Mr. Frank Parker: I don't think Dr. Ochsner is here yet. Dr. Gouoowrkt: fs Dr. Crawford here? Dr. Crawford, arc you ready to go ou? While w uimg for Dr. Ochsner, I am going to proceed with the program. Wo have an address of "The C.k? of Replacement Grafts in Arterial Diseases and Traumatic Lesions," by Dr. Stanley Cra-.vford, Assistant Professor of Surgery, Baylor University, Houston, Texas. Dr. Crawford. (Applause) Dr. St.oji.et Crawforu: Mr. President, Ladies and Gcotlemen: First I would like to thank you v-ry much for the opportunity to come to this nice area for some vacation, l gather tint I am not alone in that feeling because it -cins to tnu there arc. might.;/ .rood golfers in tins group. f'nfoft.unatvly, my talk is made up .'.round -.h'h-s, md Dr. O.hanef h:ul a different type of slide- d'h-v are i"nng l*> h iv to et w,g,* tin* projectors. You know :!i<; >Iis> in: after:-,x-I.-ro-ii lor many years lias been considered to be a diffused disease. And, *ith this coneept, it was impossible to do any- thing about it, but recently it lias been realized that it a localized disease, and consequent to this, newer techniques of surgery have made it possible to .approach these lesions directly. One of the common lesious that is produced by arteriosclerosis is aneurysm. It is, perhaps, one of the oldest known lesions in medicine. It is often a chal lenge to physicians and has been for a good many years. With the developments in Boston of about tea or eleven years ago, Dr. iluffnagel and Dr. Gross, in redoing some of the work that Dr. Correi did in the dog in.nnv years ago, were able to show that materials or tissues from one person could 1*; taken, prepared, sterilized ami put into another ia replac ing segments of the vascular system. Coarctation of the aorta when the gap produced by this lesion was ao long that an end-to-end anastamosis could not be performed, led to the developmeat of these techniques that are being presented here today. nil!, m Lbg "I.u<ihipwc.^ h-i-jvim* fey jiff III HSllS'SW 68 A nodalion of American Railroadt Many other surgeons have contributed to this field, and, of course, wc arc grateful to them. And, many, many physicians have referred U3 patients tliat have given us a great deal of experience, and, of course, we are extremely grateful to those people. There are a number of locations in the vascular system in which aneurysms occur: the thoracic aorta, the abdominal aorta, the femoral artery and in the popliteal artery. .As you know, the complications that these lesions produce are very serious. Perhaps the most common one is rupture, and, of course, along with that death. Fortunately, the patients live for .several days after the lesion begins to rupture or after the fir.-t rupture takes place, either located behind tin- pleura <r Khin i !);- j-ntr,m-'ini ot in tie groin or Ik-1,in-1 the knee, there is enough tissue Mirroij'i'bng the.-- Icmojis to tamponade the first hemorrhage that come-, ubout- At this tune, even after rm>t,ire occur.', before iiual cxsanguination lakes pi.,re. the opportunitv i- available in in-iU in.-tann-s to excise then' lesions ami replace inem ith a craft. We read in lie- newspaper about wry fanm-i- j>copj-- very rerr-ntly riving of the-- (i: and. .1" v-.: v. ,ll 1 r- 1 ail fion. reading your new 'paper-*, (lev did live for u lumdicr of dava Udon- they did linally die. If I may have the first slide, please, in the thorax several problems arc poed by tbc application of excision and graft to the lesions. We have to maintain circulation during the ojx.-ruiioii. This is an X-ray of a patient in whom a routine chest X-ray showed &n en largement in the mediastinum and by special X-ray techniques and injecting radiopaque substance into the arm vein and catching it in the aorta, we can demonstrate aneurwm hen. It also demonstrates another thine, and that is it is elott' d. An 'it;- .-:n b not ju>t a big empty sae or a lug sae filled with liquid blood; it dot', larnir.ated clot occurs in the aneurysm. Tin- liquid pan is just the sue that, a nonnai aorta would be. Of course, the wiring opera tions are not too good. It was intended to produce a clot, but, actually, they already had a clot. You can see this one extends throughout the descending aorta from the origin of the subclavian artorv to the diaphragm. Now, excising this aneurysm, one would have to maintain circulation be yond the aneurysm while 011c is excising this in order to maiutain circulation of the vital organa beyond the clamp, the spinal cord, the kidneys and 60 forth. Next slide. Again, if the aneurysm is in the arch of the aorta, say it is here (indicating) iu the transverv segment of the arch of the aorta, the main branches, as you see, going to the bruin are involved. So, not only would we have to maintain circulate a beyond to nourish the s-pinal cord ami the kidneys and SO forth, but Wv woUM haw f-> > ipplv blno-i In (In- ijumminnir and carotid arteries here in order to nouri.di He l-r.un in the ojyraliun. The brain can't uo without blood but for about four or five minutes without some difficulties occurring. But in this situation here (indicating), the aorta is normal both proximal and distal. There is enough aorta Hint is of normal Kite between the heart, and the uneurvMii that a shunt cun In- .sutured on as you nee diagrammed here. With such a .shunt iu place, delivering blood beyond the aneurysm to the descending aorta and the 1 oi the head, then clamps can be safely applied here, aueuryrun remove*!, and the graft put buck iu its place. Next slide. Now, in other situations, in otlu-r aneurysms, this situation does not prevail. This slide is reversed, but iu this situation here, there is not enough,normal aorta b viously prepart u unox oxygen, body u and c:-.' Will distant graft rt Nc\liu ! Tin* And li fiirv'e. N.-v tli>- n'-i pain 1 - awtirv their i.mass 1: the ah*, it, or t: To t frequei. the re?; rim <; here th calcific- This correspaorta. Next This tionpathok Abo-, eegmn. a simp distnii graft <Tbi* chntiui had tv. have Ipatient By t vessel- Ifa : enouc: the rib. ancuf where f course, we are i us patients tbit are extremely . hich aneurysms .rt- ry and in the ; l,:MO I is produce , and, of course, ..--ion to hind the pleura . there is cuough mage that comes i cx.-anguinatiori ' to excise these ceotJy dying of -vfspapera, they .ulema are posed ve to maintain y al u cn- '* auo cling aorta, we c-itl :hcr thing, and r a big site tilled m. The liquid ne wiriog opera- i, actually, they aorta from the circulation be- m . tr< tul.utnn a ami u forth. .. mV i : is h<-re rci, :i >c main only w ould we ;;d the kidneys lie and carotid brain .an t do ,me ' .vuiltws ,v.,- gra.. leury . safely ximal ueart here. i the lied .< not p. nr u l Proce&Unga of Mmiical arul Surgical Section 69 aorta between the heart aod the aneurysm to put on a by-pas shunt as pre viously diagrammed, la this case t-.ere w** have to use the artificial heart-lung preparation. The blood is removed from :he superior-inferior vena cava. It is unoxygeoated blood returning to the heart. It i3 put into this pump by-pa.<s oxygenator. Some of the blood is pumped back to the fernorai artery to the body distal to this damn and then through .mother tube into the innominate and carotid artery to supply oxygenated l>l<>od to tho brain. With that s*-t up in operation. rhcii one can aMv clamp the Aneurysm Uus distance to the h.urt and branches .-uining <.d m| it. it can be excised and a graft re-inserted. Next slide. This is an .wimple of the descending thoracic aneurysm which has been excised and repiaefid by humogruR. This is the subclavian artery hero. This is the descending thoracic aorta. And this is a homogmft in place following tin: excision of a rather large an eurysm of the descending thoracic aorta. Next slid. Now, one of the most common sites of origin of an aneurysm in the aorta is the abdominal aorta or -.vhern the patients complain of abdominal pain or pulsating mass in the abdomen. With the late publicity regarding aneurysms, the most common complaint our patients have is they can f*cl their heart beating in thr ir abdomen. They, them.adves, do spot it, a pulsating mass in the abdomen, ut else they have pain in the stomach when they lie on the abdomen atid have found it; nr they have pain, and tln-ir doctor has found it, or their doctor find* it on routine ix uninatiou. To confirm the diagfio-is il don't know whether you can oe it of nut;, we frequently 9ee by an ordinary flat iiim of the abdomen a soft tissue mass in the retroperitoneal nn.-a here -.ind/caiing;. As you can -ee here, there is a lutle rim of calcium; maybe the next -dido nil show it hotter. Then you can see here the lateral. This is a lateral !i!m of the abdomen. You can sec a little calcilicd rim on this mass, retroperitoneal ma.-a hero (.indicating). This is the abdominal aneurysm alwn it ha-s been removed. You can see it corresponds quite nicely to ttis r.-ilcihcd ring in the region of (he abdominal aorta. Next slide. This is an ex i/uplc of emu Tuim '.i md f.rrn: un.-iry-m i-xpo-.^l at opera tion. This is a photograph '.ik.oi at ..p'Tation. It :mph;i.i/c.s oiu: of the pathologic charm icrintn-s of * !.:j im-ion. Above the aneurysm, the .n,rt:i is r<-.ewinblv normal. Them is a m-ruml segment of aorta fwtvveou the ren:d arb-rins and the aneurysm, making it quire a simple affair to euntml hemorrhage by q>pf\ ing damps belli pruvutudly nmi distttUy to the uneury-m for which it .-an he excised and replaced by a homograft or some plague material. This is, indeed, a fortunate situation, that is, tu most instances the major channels in the ulwiomeu are. not involved. Occasionally they are. We have had twenty-six patients in whom the renal and superior mesenteric aod colliachave been involved, but again because of the concentration of experience the patients who have been exposed elsewhere, in many instances, and sent down. By and large, this is tho setup, and occasionally they do involve th big vessels, liven so, they can be excised and replaced. If a patient has one of these h--ionu hm: and has symptoms from it, we know eoough about the condition now tu be ablu to make certain predictions. Once the diagnosis is made and tho patient has symptoms from his abdominal aortic aneurysm, we know that he will be dead within six to eighteea months, some where along In there. Exactly when, it is just-hard to predict. It might be 70 Aaaocialion of American Railroad* the oevt day, twenty /our hours later, three months Inter, it in just hard to predict. We have had some patients drop dead in the air plane station oa their way to Houston or comma up from the admitting office or down in X-ray. It is a highly unpredictable lesion except in a general way; so that once symptoms occur, they are dead within six to eighteen months. Next slide. As indicated, they can be excised easily and replaced by a suitable replace ment. It is in contrast to the bad prognosis the patients are now being treated almost routiuely at home, and the operating mortality is teas than four per cent. If they arc sixty-five years or younger and do not have heart disease, wo have done consecutive s-nes, sometimes a hundred and twenty without a (i.'.Mli, If ihi > have heart di-- u?<\ of course, the mortality goes tip consider able, an<i it is !>;'} 1-0 jx r ecut. If they have rnplurod already, that is about thiriv j/'-r o iii ,i ih<..-< ii.' A third of our entire mortality has been in the raptor, d group, but U>i> u*>n l.tiot, previously harl led to death in all caws, brine .uf.! to g.1 twn-ih:H- patk-m through ojwfalion to W dis- chaim-l r< fi- . f- ,,.11 upon tl.i- oywrution. J'j.i' i' :,n i-.';..:;iptc of r.n aneurysm ebewuere. Tliis man had two femoral aneurysms. Von s.-c they are quite small and "ill appear rather innocuouH. Tiw-y am in tin- s'-ti-c when they rupture, they do not cause the patient to exsanguinate and die as one to the thorax or abdomen would. But, because the artery is surrounded by tissues that will hold the blood dot there, when rupture occurs, hematoma forms under pressure and occlusion takes place. The other complication is thrombosis. Because of its small, lumen thrombus formation which occurs inside of it, obstruction takes place. In summary, ait the complications of the small, peripheral aneurysm is ar terial in* jtii'.iincy of the extremity. In a study of the natural course of the disease of the femortd nud popliteal aneurysms, sooner or later they will develop a complication that will lead to amputation in the majority of instances. Because of such complications, death can occur. In a group at the Massachusetts General Hospital, they wore treated with out removal; and a quarter of them eventually died as a result of their com plications. As you can see here through two small incisions these aneurysms have been removed and vc--el continuity has been ro-ostabli&hed by the insertion of these grufts, making it quite a simple operation and preventing the develop ment of these complications that J- ad to disability. N`e\t slide. Tl.iJ i- j'i-t an `Aainnlc of popliteal aneurysms. Th* so, sometimes, are dif- ticult io lV< i In ;.nv r-'iji it,'- pt -ical evvn.in.it ion. tic pul should he Ml in tic ehar:ii-t>Ti in- lo.-atioi, . in ln- fitnorni, popliti al and tin* f.-ct. Not only <1<k v it giv<- \:i some idi-a as to the adequacy of their circulation, but it also will help to pick up these lesions which may be il<*nt at the lime. This ia an aneurysm behind the knee, and it has been exeis.-d and replaced by this syn thetic substitute. The one that we are using routinely at the present ia a knitted dacron substitute. Next slide. Now, the next, and perhaps the mo.-t common, arteriosclerotic and vascular that we sw is an arteriosclerotic lesion that produces poor circulation, arterial insufficiency of the lower extremity. Again, you know, up until not too long ago we thought a fellow hod poor circulation m his f**<-1, that nil of hi* arteries down his Jogs and feet were evhut . just hard to :;e station on vn in X-ray. -o that once table replace>'UMg UftlU-d ii.in four ;j<*r .art >!v-''ase, .ty a it hi iiit a up i,'in-idLT- ii.it is about been in tin; in all citses. m to bo tlis- . Uvo femoral r innocuous. ... patient to id t* lood in<} -ion 01 n. 11, .: rakes iacc. urymi is ar- .>nd popliteal .c Tvill lead to \>replications, treated withof their '.-om- -.3 have been Mi-i-nion of he dev-top- ws, are difi.oiild b<* felt ?t. Not only n, but it also *. This is an by this syn- nree-'r.'. 13 a and va- f tn>n, ml 1 > hlld {/ .t ! Proceedingi of .\fedical and Surgical Section * 71 off with arteriosclerosis; there wasn't much we could do about it except a lurabarsympathectomy. si rice that increased the circulation of the skin, aod, after all, that is the way many of the b'-'iuns that lead to amputation originated from, ive not some help from a rimbarsyms>.uh-ctoir.y. Hut, all too or ten symptoms were not relieved; in the more advanced cases, amputation was not avert<1. As lime went .dong, it wad discovered even here it is a localized Irsum. I think you ('.in hem tin* patient with symptoms in Imth lei's an<i with ab-erit pul (> in both lea.s .md mi arrenographic. oxummu- tion, a '-ompleti: obstruction pt-i i.eyoml ihv renal arteries here, but diMaily there was good liiling of i|.,rm il liiae arlenes on burn -elr* an von can see here Hum i|iilie mcclv ! iuoi.-u-ithc; u.o I......dired c.aUue ..f itu- cvIimv* This -hows :iiioi tier more 1.1 vi no--1 u t>-nm auli thrombi >ms n-vonding up to 1 he renal art'-fies, p m ;.iH v or j-i ru> nog i renal artery on one side. Next -Iide. Due to the localized nature of this di.-case, it is also treatable by the direct surgical techniques; m tiiis instance here the diseased area was excised and replaced by a graft, thus allowing normal blood dow to go to the lower legs. And in tiiis situation here the obstruction was not excised. It was merely by-passed, using this new vascular replacement in an effort not to disturb the collateral circulation tnat he had and also to simplify the ojwration; in this instance the end of the graft was sutured to the side or above the occlusion and then down below the occlusion the ends of the two iliac limbs of the graft were sutured to the patient's iliac arteries beyond the occlusion, thus allowing the by-p-.res route around the obstruction to restore circulation. Next slide. In ch.3 situation here, again, the mi I of the graft was sutured above the occlusion, and then the two iliac limbs w.-re brought through tunuvls made by blood -iisection down to the groin, thus by-passing a tong, extensive oc clusion in the iliac system bilaterally. In tiiis way a rather simple, uot too major, operation was performed and immediate pulsatile circulation was restored to the lower legs -.uni the feet. Next .-lide. This is another example of the type of operation that can be performed. The lesion was excised here. Tiiis part >>f >he h-ion wm evt-vd Ix-cause an aiieury-m w is in tiic pre- of !< :>mg is U a- l ill- ob-r.rueti.m. I hi <>Qe -ide an md-bJ-ond una-ioni.cM was m do b-i-.v. o >!. diae urtorv and ihc iliac end of the graft. On 'he other -id" a i'Ia-im. (i down the groin. Next dido. In all of the occlusions in the aMommal aorta and iliac arteries are sus ceptible to those tcchnici'ie.s. And. given a patient with arterial insufficiency of the lower extremities, whether it is pain at rest or ischemic lesions, early gangrene or whatnot, if he does not have femoral pulses in every single case a normal circulation can be restored by these techniques. Consequently, just the mere demonstration is all that i3 necessary to say that he is a candidate for an operation. `Now, in not quite half of ail of the patients with arterial insufficiency, the lesion is uot in the abdominal aorta; it is out in the thigh, out in the leg, as it is demonstrated here. This is an arteriogram of a patient with a segment of an occlusion in the superficial femoral artery. This m rim femur, and von can sec tiiis gap in the column ut dyes. That is a localized oee.iiMuju m the femoral artery. Patients who have the milder forms of arterial insufficiency will have such a set up like this m ninety per vent of the runes, if they have advanced w 'iy u ty i ft T** *' 72 AiJocio/um 0/ /I rmrican Uailrocdt arterial insufficiency with a lesion localized to the thigh, that is, they will have a good femoral pulsation hut nothing beyood, only about half of them will have this. When they do have this, they are a candidate for operation. Those who do not have a good distal segment like this are apt to have an arteriogram like this over here. As you can see, there is no distal segment of eufEcient size in which the graft can be connected. Consequently, in the thigh, all the patients are not candidates for this direct operative maneuver. But, in the majority of them they arc. The oniy way it can be determined is by an arteriogram because t-oine of the tr.o.-t severe forms of arterial insufficiency wiil have a nice 6clup like tl>!>. Vet, son;'- of the mildest forms of arterial insufficiency will have a wAup like this. We have lo do an arteriogram in order to select the patient. N-\l ilnleThe operations we pri !t-r in the tlmrU will make it n pimple operation. It is not murii more of a cut t mg ? -rt oi .ip.rnt ion than the varicose vein operation. Tie s>n> 11*'* an- c-p.M i ll.iwngn r. incisions, one i up in the groin, and the common femoral artery is exposed here. After controlling the vessel proximal and uiial to win re the incision is to be made, the inciojou in mad*-, following which the end of the graft U sutured by a simple over-smd-over suture to the side of the vessel, following which an instrument like a vein etripper is passed by blunt disection to the other incision which has been made in the popliteal space over the normal distal segment. The iV' t end ol the graft i3 tied to the end of that vein stripper and is pulled down to the oti.-r inct-i-m. The expm.ctl artery then is open, ami thv. end oi that graft is sutured to the 'id.' of the normal vessel. Thus, the operation, then, i> designed merely just as to insert a collateral channel immediate!) oi the size of the vessel that is plugged up. .So, it in quite a natural sort of ojicrution. The patient* own collateral channel* arc not inwrferred with. This is the desirable feature of any operation in much if some thing hup|K.'ns and it fails, it doesn't make the circulation worse Next slide. This shows such a graft in place in such an operation. This is a plastic tube sutured to the common femoral here. It is under the skin dhwn to here. The other end of it is- sutured to the popliteal artery. Next slide. This is another exumpi". You see the two smaller incisions here. In this incision, this plastic tube lev* been sutured to the femoral artery, to the side, above the r:e!u.'i "ii and d-> a n her.- the nl Ii<t end ha- been si it nr-d to the side of the patent .........I b"i*w . N'eXt. slide Now, it i-ai I lb1' i-'g ;iiid tin nlxli.11,1 i,al aorta and iliae arteries that are attacked by this lesnm. Tim carotid arteries arc also involved. I am thinking now and speaking now of the stroke syndrome, (JVA, stroke, hemiplegia, many common terms lof patients, old folk.-, who develop strokes. The average doctor even today thinks that u patient has a lesion inside of bis skull, lie has just got a th-gein ral ive h-.-ion, and that is tough. lm the Wst we can. (live him anticoagulant.' to keep him bom getting wuf.-e. JJul mure it is inside the skull and dealing with sni.dl vessels, it is felt thut there is just nothing much to be done about it. Well, that is an erroneous concept because in a quarter of the cases of patients who have 6trokes, the lesion is uot inside the skull; it is out of the skull in the carotid artery. This is the internal carotid; this is the common carotid Von will notice in this patient here there in al most complete obstruction m the internal carotid artery. hs Hr La. ae. by oi `d ic Y n teth- tte I we ing op. I wh, pat les: the arc tin: h:i'. If! 1 an. etor \ I get \V. fte>" Thpro Lit). the ext' . they will have 'hem will have <n. Those who rtcriograrti like r.iicicot 3120 in -il the patients .i the majority .a arteriogram ill have :l IUCC utficioncy will t to select the operation. It .*`ia operation, he groin, and .ng tho vessel isioo is made, v<*r-and-ovcr ut y vein ei* '-ile r -i.nl is polled \d the <-nd of : a collateral :*>, it U quite vro not imoraueh it sutne- .here. Tin! re. 1:, , to tho M<hi, i to t:*e 'i le 'if* that are ..7i thinking rrieapft. many 1`he average j skull ile eat we am. c it in itmulo ..it nothing r:m.no in n t i/i-i-lu tho nn l; the Proc'ediruja of Medical and HunpcoL Section 73 This patient was having these transient strokes, and in some quarters they have beea called ``chilis'' lately. This patient was having intermittent strokes. He had been completely paralyzed oq the right side of his body and couldn't talk. They would last anywhere from five minutes to a half a day. You can see thia localized area, occlusion, here in the carotid artery. Next slide. As 1 'ay, a quarter of the patients -vi111 .'trokos have such a lesion as thia accounting for their ->nditi<'H. Now, a quarter <<i tko.se patients `cin to get by. The reason they got bv is !>.> vi*t; ihey gi t, collateral circulation on tho other side. Here is a cerebral arteriogram 'bowing filling of the braia on the opposite side of the ncdu.-ion. ft is tilling through the iutcrcraniai vessels, and this patient, although he had an occlusion, bad survived a stroke and bad no neurologic deficit. Neat slide. flere is another such patient. Because of go.*i circulation through the external carotid through his eye, he had good circulation inside of his head. You can see these n-robral vessels being filled through the external carotid artery. That fellmv got by. Next slide. Unfortunately, from this lesion only a quarter of them got hy, the residual neurological dirtiwt por'i.il.i ui a third of tiw patient*. And, in a third of them, the institution of <*? U required. Svmcwbvn* around ten |k.t rent of the patients die. Consequently, therefor.-, u, n important In r. utizc m puieula with strokes the lesion w outside the -kull in tl.e n*-ek. F.ven .io, the prognosis is poor. Next slide. Because of the localized nature of this I-don to a vc*-et of sufficient size that we can perform an anhrotor.ty and dose it without producing undue narrow ing, it is susceptible to npi-nti' n, :n most of caacs a very simple operation. In the first [dace, ih-.-v .ire -.-i.-i-ted :< r by a carotid arteriogram \ UU-h i' ''.-me under on i u-i: g i -n; ill .mount of -Ive ->n tu out* (alient b ..-is, if necc-siry. If mev ......... 1 fur .iprratioq for tho krralzicd '< -hui, it . < d.me und< r !" ii on- -h- -ia \: in.-i i.n u made in the re-clc, and d;e r ir'iud, eiiiiiinon r.irxn 1. e\ii-ru.i note) and internal carotid arteries arc mobilized like ilns. They are teinpof.irilv oirrbjjed, We feel that circula tion dor.H not have to be maintained during ibis pen.*] ,f planting nor do wo have to u.-e hypothermia beea'i.-e patient* have chronic arterial iti.-uiifiricncy. If the operation does not take long, it is not necessary to maintain circulation. We cm across proximally this which we have shaded here, and the normal arteries peal back from over the atherw-i-lerotie material. Continuity is re stored by an 'nd-px-tid .nixstarnosis. Next slide. It is more important, we fe*-|. to make certain air bubbles and debris do not get into the brain. We feel it is important to make certain that docs not occur. We do it in this way: The clamp next to the brain is removed first, and the back flow of Mood eouipreH.u a the iur and pushes it out through the suture line. Then wc re-apply that damp right near the suture lino. Again the nir is com pressed, and the proximo! one is removed, and g'x-H out through lh suture line. And, as a Just gesture, tho internal carotid is u-nijioranly clamped wheQ the proximal clamp is removed permitting air bubbles and debris to go into the external carotid artery. Next side. This is the appearance of the umitv in mi actual operation at thn end of the procedure. You cun fr.-c here is a simple unuitumoms, aud this ia the material that was removed that was oli-struriuiR the blood from this patient's brain. Next slide. This is before operation. you see the common carotid and the internal carotid almost completely occluded. I(- r.: i? the situation after operation. For all practical purposes he has a normal channel taking blood to the brain. In this case it relieved it. It ha* been over a venr now, and he has not had a stroke since operation. Next slide. This is the maf rial r'n;"v>-1 fri.m another cn--. You can sec how it bcadvd down to a very small lumin. Next slide. Tiii* is a ph'-ti* nii' ioe:: ;.'. ) >-n(^>f'iZi- tin- Im-aii^d uaiur.- of this lesion. T'.i.* is un atn* A- you know, when we cut it with a kiuiV, a lot of it fragment- an<l o n Tl 1.1 n:i .it brrwn.-i right m I.. r<. ;il:i,i<-f oh .i >:r*-- it.- ! - ( .iri- rv. S-.- h-i-a ticautu.ili\ it j locaiui-l in i:a-> t r- i:.><igh! thm whvn it vessel was Hch-rotir it u-as just n lint'' pipe Next slid.:, Iu other carer we haw to u?vg.-.ik end uru.-roctomy. by the technique I have just dvscribi.-], it ii not applicable. In such a case we use a graft. In tin# case- here a graft was un d to hy-piv** nn obstruciion in the origin of the internal carotid artery. Next tilde. Thir ir such a patient; you ?--e her*- ri,-- internal carotid artery being partially ole;r:;--t' d by Ira- 1"-'.'J;<- i p; When this artery was expi.-cd, it ivu.- fiuind to he a type m ait'-r;.- 5:. a >}.*. not lend iisdf to endarterectomy, con sequently a by-pa?? gralt yya.- ui.-eried. You can sec it iu place functioning in fhi? slide here. NeM al,de. Tin? paiieut yyas hming cyr ?yiu|*tmu, temporarily blind in the eye and temporarily paralvz-d. Folhm-nm the op.-ratioti, In- has not had any difficulty further. Next slide. J'4 The second common site oi the ksious pro inomi arterial insulFicieacy to the brain is where u originm-.-- ;'w;i the no.-la. If- ri- is an example where it original erj at tin- origin -f t!.-- inmvu.naie wpe-h i- the artery that carries blood to the brain on the right It hud i-v.-ud^i <m r-i the ?ubd.iviu and the carotid. In (hi.-* ease, ihro ign tlirn- mi i-ioi,- i-.vn in tin- n--':S; ami on>- in the ebest, vve Yvt-n- able to unx-tutuo**: :i grail mi in the a-vi ndinc aorta, one limb of the subclavian and out: limb of tin: carotid and restore circulation to tfie arm and the bruin. Wit have, had three m-h cases ., this, and circulation was successfully re stored in nil three of these patients. In fact, one patient had obstruction to both carotids. Next slide. This is a photograph of that cast*. You cun si-e what it is. This is thediagram here, what i have ju-t describ.-d. This photograph ns where that square is. This is the ascending aorta with the Mump of tin: graft here. Next siide. Now, this is the limb it Next slide This is an storing circui Next slide This is sue this graft. \ this graft cor Next slide Now, t un related to it Thi- i> a run thing of thru h.-youd tinwi.fth-r il ' i.s what giv<- This i< a Her doctor : ciiaucc to uremoving th. saved, anil h- So, it is on. the yuuugudreds oi ju.-rtension 400 to the Next slide. I run sure itie Icsionsttanccs, d< H. Aod, . wasn't in It is itnpor st as soon undue dcia ood for a s If the tow storing cu tvv them Now, in .ceration or i?l a mere jgea togetk Even in uccd by t fter the wo mobilized ac e put toget ,,rv careful ie end of the the material 's brain. crnaJ carotid ton. For till Min. In this id a stroke w it l.<-;vh*d I nature >( ..ih a kudu, cere. almost amifully it ns sclerotic inch ` -'ic I tfu :s hem d ng partially >ed, it was ctomy, eonfuacUorung %:e eve aud v ::.Ticuity . I- i:rv to ,ir -.V tf -rc It a arrirn m .tici the i ;`i cheat, uub ot the .* arm aod safuliy re.ruction to i':ua ia the vticro that re. j j , i ' I [ j I I j , l i j j j j' | ', i i Prot'tahnf/i of Mt-hcal u/t-l Surgical Section 75 Now, this is the limb that is anastamosed to the subclavian arturv, and this is the limb that is going into the neck. Next slide. This is an anastamosis on the common carotid artery, this point here, restoring circulation tothe arm and the head. Next slide. Tills is angio-aortogram following the operation demonstrating patency of (his grm t,, V-m h.iv.- i i.lt-.u.-jr 0,11 i.-t*- deiiioirurtt mg <h e* ihming through this graft carrvuig t-lo.nl > i n- u m i)i<- 1 >r-ii(t. Next .-lidir. Now, this is mother I'uidi'ion. If it isn't ;w terinseh-roM*, it is certainly related to it. Tint n a |o.- di/e-J, -'ginental oer-ludon of the renal artery. This is a renal artery h-re. V-*u an -<: it looks like a chain of In-ads or some thing of that sort. What that is muitipie, localized occlusions with diUtations beyond the narrowed area. That is the phenomenon that always occurs whether it is an arteriosclerotic artery. There's a dilitation heyond. That is what gives that appearance there. This is a young woman, thirty years old. She had severe hypertension. Her doctor heard a bruit over this kidney, and prompted us to give us the chance to do this study winch wo did, aod demonstrated this lesion. By removing that localized lesion and in.-i-rting a little graft, the kidney was saved, u;d her hyji-r'i'ti.-ion r- iicv-L 50. it is our feeling th il any pat.-.-uls .vith une\pl.in. d hyper ten shut actually in the young-middle-ige-t group dronld he -Tunied bv (his (--hni'iuc. Already hundreds of patients h ivi- hi -ri dc.-nmiur.tt.'d io have such a lesion, aud the hypertension cao be cured either by removing the kidney or by restored circu lation to the kidney. Next slide. I am sure that anyone associated with any industry is interested in trau matic lesions. Well, 'he traumatic.le-ions an* easy 1 cause we are, in most instances, dealing with normal vessels, and they sew well; they do "uturos well. An-1, usually, ti.-.-. in ......i -hope. lie .vooldn '. he working if he w-.m't n pretty good -hope. It >s important if ike per-in his an art. ml mj-irv to I ,r.-.- thit r- p-iin-d ju-t, -u --.!) f t<><- il>h\ 'I'i.c o:uv itin ' . .1 |.1 i t 1 . ml r mod is undue delay of any operation. 1 or . ..uapl--, n mn.-cio ti.-sne goes without blood lor u smiicient period of tune, it develop* irrever'iblo changes. If the lower leg beo nrn 'S ..wolh-n ,iH-i --f '; and an-' ,l pet ic. ! ho di iin-cs of restoring circulation, although ;,o.-.-iblc, are not too good, it is e.feontial to have them operate upon it ju.-t as .--Kin as po-..|lle. Now, in most instances, a graft is not nere->*ury Ixrcaiise the injury is a laceration or a stab, cither by some sharp msiruun.-nt or by a bone, an 1 it is just a mere debriding or cleaning of the local area and bringing the lacerated edges together. Even in those instances where a considerable defect tu the artery waa pro duced by the injury, a graft still is nut necessary, in most instances, because after the wound is projierly del.rided, the artery, ln-ing mi ei.iauc. ude, can bo mobilized aud brought together under tension. U is essential that these vessels be put together under terwioti in ro/ur,i>i to tins bowel, lu the bowel, %vt* are very careful to make certain then; is no tension. It is the direct opposite in these vessels. They have to be uoder ten-ion. A. 76 Attoaalion 0/ American Railroad* By mobilizing sufficient length proximal sad distal to the cut areas, the two ends can be brought together ami sutured in practically all instances. That should be. done Uecuunc nil extremities, practically, can be saved in contrast to in olden tiroes when ligation whs the common form 0/ therapy. For example, in World War II, when the femoral artery was injured and ligated, hall of the legs were lost. In this day and time with our city and county hospital, this injury is not uncommon. Our residents repair those, and w don't lose any legs from laceration of the femoral artery. If the popliteal artery was. lacerated and ligated, better than seventy-live per cent of those legs would drop off, where our residents repair popliteal lacerations. They don't lose anv legs. Coii.-equcnilv, i( i- a form of thi-mpy that is associated with preservation of the exlfcmin, ami ib< prevention nl tJ. formm . Next slide This is wJht- n< might though, of some delayed traumatic Ivsiuti*. This in-in .dual J,.i-i a Jaei-r.-.tn.n -.1 the brachial artery at this level here. It was repaired at hum hospital Not too long alter discharge, he developed a mass- lie tmtin-f inr.t it thr-.l-eii and piil-ap-d. Next Him-. It was for that reawn that he was admitted to University Hospital in Houston. You can see at njwration what had hapfx-ned. Here i9 a blister or n mass on the artery, ami it iva- made up of clot. What happened was the artery had pierced by u sharp instrument. It bled, and lie developed a pul sating hematoma or a false aneurysm. Next slide. In lids X-rnv is demonstrated quite nicely the axillary or brachial artery here with this glob of dye in this particular area here which is in the aneurysm. Next slid*'. That was simply excised, and von can see it was several inches of excision which were required to get nd of that Jet-ion. Having mobilized it proxiirmily and disudly, it rmdd lx- brought together. It was butim-d by a simple over* and-over suture. Next slide. This i> a summary of the o|s-ration. up to several months ago in our de partment in Houston in spite of the large number. It is presented merely to indicate that in our opinion it is a field of surgery that is safely established. We feel as though this has {lermitted restoration of functiou and prevention of loss 0/ both life and limb. I am going to pas? around one of these new synthetic tubes that we have been using, It has a number 01 desirable characteristics. It is flexible. It is very tough, strong. and it ta-ts e<-riuinlv for a Ions, lone time. It does not fray. I( can be `-ni v.iil; th- .av.in amt ;iiur>-d without having it frayed. You cuu raai.e an u.< im>>h in tl,e side m.-i x-w another graft on the side of it without it imying. Thi only un.--tind iharactcristic of this tube is like that of all aynt belie mule rials, and that is it is pnroiiH. One Ua? to be quite careful io the use of it as in all of them that new bleediug docs not take place. But, by soaking them in the patients blood, proclolting is reduced to a safe minimum. Thank you very much. (Applause) Hr. I. GohyowbKv: Thank you very much, Dr. Crawford. Are there au.v questions from the floor, aay discussion? Dr. Bennett. Db. hu b< Db. to my years, have 1 have u InL Dp. uf L>r. the d. They cent i aru.r. Pat iusta.;; \V good from c and ov Dr. Die Bucre-ss treatm De. aufhcie with ac The were Ia arters CeliC hove paUe some teric and tion the 1 \ ut areas, the two instances. That :vcii in coutrast PY- was injured and ir cuy and county iir ihu.-tc, and we lian .cventy-rive . c. pair popliteal Mb preservation ratimaiic teaiooa. .is k-v>-l here. It he developed a ity Hospital in it ere is a blister .-j <1 was the ie * pul* r brachial artery in the aneurysm. aches of excisioa red it proxitnally* hv a -ample over- r.i -.ur -!<.......anil niifidv :-lv . ihii D-d. ,i ilid prevention -a that w have . >3 slenble. It i* ;:ne. U doca not having it frayed. : on the side of it i tube is like that i l; quite careful lake place. 13ut, j ucoil to a safe i. Procetdimt o/ Mviieal and Surgical Section 77 ! Dr. It. J. Bennett: Wlut is the longest period of time that one of tht.se has boon in pi.ice and found -ctrisiurtory? j i Dr. Stanley Crawford: The longest period of time for a synthetic tube, to my knowledge, to be in place and use in human beings is approximately four j yearn. The one that I have here of tins Hidi.Hl.nce, the dacron, the longest we j haves is about three years. Now, this particular brand and manner tfiat we have treated this, about n yv.ir and a half. j In laboratory animals, ihev have been in, i think, about six years now. ; j Du. It. .f. lihNXK'rr: l\ hen tun !> an aortic, do your p.divots have a lot of pain/ If so, f.iv <|o i-ni rH.iprol il.atf Dr. S. Crawford: What we do is give the patient a barbiturate to prevent the development of convulsions, and also give them a good shot of demerol. They have at the time of the injectioa the contrast material, we use fifty per cent ilyopaque, about eight ccs. which is injected in the common carotid artery. Patients have a warm feeling in the face and the eye and the throat, in most instances. It is not too disagreeable, although they don't particularly like it. VTe have followed these canes along, ai I raid, on un out-patient basis for a good many months following operation. I think the fact that they still come from considerable distances and permit this type examination to !*> done over and over as a follow-up indicates to me it is not too bad. Dr. I. Goldowskt: Dr. Cushman. On. G. F. Ccsiiman: I would like to know if Dr. Crawford has had any success in demonstrating mesenteric in.-uifinency, :ui ho, MisceptiUc t*> treatment. Dk. S. Crawtoro: W.- have mu 1: cl a ..if;, ni wiih chrorm: ari<-rr:.| m- *uiliei-i:y ot the ujierior un -.-n -rir- j vr-. not Ii.,d |,m, ,j,c. pa.ue.ut with acute arterial i:nu:!:<,;..ii.-y ..i -ijt>- ri<>r :,..;.v-:iierjc artery. Tie: latter patient .n< kim i< !: -- in,-' ,..itw .u.-nry -rn, liihoiigh a<- WiTo .micrf.viitji IM l-loUlig < ifolUllot, to lu>: bo.w:l <>f lj,e patient, he did not survive his disease. I am xtiro you are familiar with Dr. Ilobcri. .-h.-uv's work in tin- chrome arterial iustilCciuiicy of tl,o Miperior mcseuunc uitery, and the Massachusetts General Hospital where they have a very active gastro-intpstinid clinic. Tln-y have quite ft number nf patients with the Hpmc nyndromo them. Knowing the patients have no emliohia of the superior mesenteric artery or ineumtcric thrombosis or what have you, frequently have diarrhea and so on. Hu studied some nf these patients, those techniques, our ateriography and were able to demonstrate in some of them ilut they had <K-c(usious of the superior mesen teric artery. As I understand, he has operated on two of those patients now and has bees using these direct techniques and has been able to restore circular tion and relieve them of their iligcstive disorders. UNiDEimnao Votec: fa there any occasion now to use the old wiring of | tbs aneurysm? s; Da. Stawlcy Crawford: I wouldn't. I am hjgidy doubtful there is an occasion for the use of the winog operation at the present time, but I certainly 78 Association of American Railroads would want to be very careful in miking such a statement as that saying never, because I was fortunate enough to be iu surgery when that operation was still being done. I can recall patients who had severe bronchial obstruction, say with collapsed lung on one side aod having a great deal of trouble, and we would wire the aneurysm: something would happen right afterwards; it would permit a better airway. This bronchus would open up, and the lung would become inflated. They would just be better, although their total life didn't 6eein to be extended a great deal. The aneurysm wont ahead and ruptured a few months later. I have seen in some instances improved aneurysms, appear to be, by what was done; whether it was the wiring or not, I don't know. I can visualize the pox-ibdity of a patient with a iarge thoracic aucurysm that was obstructing the trachea of the lr<>nrlui.-, and the patient's age or general condition or something would not permit the excision aud graft. I would think that there would by ttm- s wle-u one would from thy local anes thesia wire Mich an atieurv in, j--- -u-Iv I don't know, 1ml l lUinl. it would lu ll pos-.il/ih iv. Dr. I. fioi.now.sjtr: Any other innv? Dk. F. S. Mojirison: Dr. Crawford, that was a very nice paper. I would like to ask when do you recommend carotid arteriogram to check for these carotid obstructions'/ right after the CVA or after they have recovered from them or had something to dq with the extent of the original accident? In other words, if they have had a severe one, complete hemiplegic, do you recommend it at aii? Dr. Stanley Crawtoro: In my opinion, there is do delimit- way of making the diagnosis--there is no way that I know of--that you can be certain of tell ing whether or not the lesion ie inside or outside the skull. In other words, there is no way that 1 know of you can L-ll whi ther this patient is suitable for operatioo that will relieve him, short of an urtcriograra. The ouly way you cau be safe as to whether or not this patient ti a candidate for an operation which in my opinion is being established. As far as I am concerned, it is estab lished. But, more aud more referring physicians are being convinced of it which is a good sign, and I think they should be routinely performed on all patients who have strokes. Now, once the internal carotid artery occlusion becomes complete, although il is localized, tlv Mii-roinn a tl.iombii' <hvi in| on lop <i it. Then- are uo branches of it; tln-re is a long segment of internal carotid outside of the skull. But, it has no branches. fivvn (hough this hltic idiort thing M"i i.. ofl Hint, biond doesn't stay Ini'inl ill tbal big long o-gii"``it ; il A i n J, III'- !< ion t lx - n Joc> c.\l<-nd iimoIi; of the head. Under those circuinaiaiKva it does Ixieoinc an impossibly situation from a surgical point of view unless they oj*>rnf<-d upon him very early. Of the completely obstructed nrb-ncs of the iiib-riml carotid group that success was obtained was iu one operation upon a patient right away. We were able not only to take out the atheroma but pull the clot, out like pulling &u angleworm out of a hole. Sine t his patient del rmt have u severe stroke and consequently had not had irreversibly changes in In.-, bruin, he recovered. . Now, there uo question but what the best group of those in which the. occlusion is incomplete liecausc it is stul di-ereN; and localized, aod it is in that group that the svndrome is more pt t<> Oc the small stroke, the transient one. The longer it takes to recover from it temporarily. I The fact that t: think they might over and over who become complete. I think that yo single one of then A fellow comes that has a patiei. charger and have saved. I think ti. I think it is a hospitals I have f saddled with tl.<-service to take tblike to take some who ordinnriiv nr It reminds me . was assigned to m around, and he u. donkeys in North droplet. Well, m; droplet. He said condemned the 0 let in North Afric I think these pn able, and perhaps have not been ver;- I think since so longer an incurub. able. Dr. I. Goldow I want to than. (Applause) Has Dt. Ochsu' I have one litt ) the-rccord disco very carefully ci. merits for Mrs. G !> put in tic- pr; olliry in Chicago ; If anyone is in thing that was fa ably to get it froi Dr. Ochsner b to call on our 1. Walter R. Kiwuto be put in ofdc: While tliey arrecess. (Short recess.; vying aever, -.on was still ruction, say UQd wo r03; it would lung would . life didn't : ruptured a )*, ly what .0 uiicurymu jnt's ago or .,d graft. I local anf*a . it wrjiiid bo r. old > * t* ViT'-i ...on ,i` liK.Uu-r r'-com:ii--nd .y of making rt.iin of U*U- r. r; r words, - :it.iblc lor .iy way you . >(.. r .U'm . r io -Li '. ilH-r-d Ml It `1 -m vtl <, although , u. a. nide of the .tay liqtjiu -.no binde `i `ituatioa ..-iy. Of the ?ucce** waa re able oot angleworm naequently wnicn the .t is *liat .031 Proceedings of Medical and Surgical Section 79 The fact that they have had this little thing and they have recovered, they think they might not have it again. But. the majority of them will have them over and over whether they are given anticoagulants or not. It will eventually become complete and what I raid would happen to them on that slide. I think that you have to apprai.se all these cases with an arteriogram, every single one of them. A fellow comes in with a bad log, there isn't a doctor, certainty in Texas, that has a patient with a b.id-looking leg that doesn't jump on his white charger and have something don.* about it because he thinks his leg can bo !av:d. I think the same thing about the strokes. 1 think it is a bad thing about the old CVA in a stroke patient. All the hospitals I have ever worked in, it has been a light as to who is going to be saddled with those patients, the medical service trying to get the neurologic service to take them. Now they are very happy that the surgery service would like to take some of them. It is condemning to doctors to attend to patients who ordinarily are not too agreeable. It reminds me a little bit of one oi my chemistry professors during the war was assigned to making booby traps for the army in North Africa. lie looked around, and he made a very' '.-ifcctm: one. As you know, there are a lot of i dunkuys in North Africa. At that particular time it was covered with donkey droplet. Well, my buddy dovi-cd a boobv trap that t-iokcd just like a donkey 1 droplet, ilir -oid that i!i<* gnuiieit thu.g he gut out "f iln* war was that he i condemned the Germans to contemplating and inspecting every horse drop' t in North Africa. * f li.ink those patients with the CVA's and what not are sometimes disagree able, and perhaps we are condemned to taking care of the type of patients that have not been very popular in the pa*t. I think since something can be done nU>nt Ihcso to n.-licvo them, it is no longer an incurable disease, and in many in uance-i they will riot be disagree able. I)n. I. i .ui.nowsKr: No non; o-i'-.iioris. f vtrit to thank you v-ry much hr. <'i r.viord for n very line presentation. (Applause) Has Dr. Oehsner arrived.* I Lave one littlo item I want to talk about. We have had quite a bit of offtho-rccord discussion hero. I want you to know that aii these proceedings are very carefully edited before tfuy go into final print. Wc have made arrange ments for Mrs. Gore to make a separate typing or transcription. It will not be put in the proceedings at all, but it will be available from Mr. Parker's office in Chicago for reference only. If anyone is in disagreement with that, please say so. If you do have some thing that was said oil the record that you want to refer back to, you will be able to get it from Mr. Parker. Dr. Ochsoer is still delayed, so 1 am going to go on. At this time I am going to coll on our Railroad Retirement Board, Mr. Eugene E. Koch and Mr. Walter ft. Kaolle. Will they come up here? I think they have a machine to be put in order. While they are murchmg up here and getting ready, we will take a short recess. (Short recess.) 80 Auocialicm of American Railroad* m i Da. I. GoLbOtvsKr; Gentlemen, will you kindly be seated so we can pro grate, ceed with our program? At this time I want. to introduce Mr, Eugene K. Koch of the Railroad Re tirement Board. have Cetjir years Mu. Eugene E. Korn (As-istnnt Director of Unemployment and Sickness As noma Insurance, Railroad Retirement Board, Chicago, Illinois'}: We are going to years show you au audio-vi-uni presentation about unemployment insurance. seen & This presentation has been developed by the Iiailroad Retirement Board and has bcou approved by the Association of American Railroads. As you know, the Railroad Retirement Board pays unemployment insurance benefits. Those b.-tieliis are iihrnned entirely by contributions made by the railroad'* The management of tie- railroad- Imv I won jmro.vinglv concerned ov'-r tin<081 of ii!u`!)ij>l'iV)c< :. !m;r' - and ncei-ur. - that can t"' taken to k.**-p rr perjeii'---d i>< "j I" v.a.f iae Tin- ptv'. i.i.nv.a v. m<: . an- .d.oui n, - bow vou indicates the ueenmpii -h* incut.- 1 i.at ii... >.-. ! . .. 1 i.\ t?.< <..ilmb\ ihe Rmh.i/id Rclirem. lit liuiri;. v.'.il.i:-: i..g. ;inr I: gi\. some i>n of what v.e might In [> for in ine liui;n . We nr- r. a.i-.' t>> dc-v n-.v. O'rt-'eiilaiiou ''Keep Experience at Work."} The o: thorac W< m-.tii r jTL'll: S im. of t 'i ' . t j 11:0 JU< of eilf. D. rill. Th- in in-.: Dn. i. Colhow.-k v: I believe Mr. Walter Knullc has a few words. among I'roi Mr. W. KNOJ.I.E '.Railroad Retirement Board, Chicago, Illinois); I will smoke let Mr. Koch speak for me. doubt Mu. Iauj.m: K. K`-< u: i,,m!em<n, I really have nothing more to my. 'J'li': ii':.. and jo'mdti.-u: .-p..a:. mr Uwmxdves, but Mr. Knollc and I will be glad to liic-wcr any ipicMion*- that \oii might have. That takes care of that part of the program. Th. IlOW, lung ( the gen Dr. I. Gou>ow>ki: Any ip.estious from the floor? Does anyone desire to ask Mr. Koch any '{uestion-? If not, that is it. i would lit;** to assure the Railroad Retirement Board the Medical and Surgical Section will do alt it can t< help keep the men on the job and off the job in other jobs*. Mlt. J'.i oKNt: Korn: Thank von very much, Dr (ildm\>ky. {A|>|ibm>ei Thank j .*u all. And cancer tin: J; taken Oil aTM-im Dr. J t iiil.|n/ r.Y: ,\ t lii- ! m.v j w i i.l l u jif* tee* d " 11 h our meeting, u'ld in1 v ni hn * >-ir : ; in - ..n " N < mkii - >n I * -lances - n ( me-at ive I- actor in (`.ir I'lnoma J f< - l.ui.r . i in. Alton ii.I.m,..!, I'i.ho-ui oi iurgery, School oi Medic.uv. Tul.u>*` I'nivcn-tty; Dir.'clor of Surgery, Oclisuer Clinic and Foundation }l<>-pitn): Dean of Visiting .Surgcnns, Charity Hospital; (`on.*,ul ting, Illinois < Vntrnl Hospital, und Soot hern l'anlie itat In y. I cun tu-Mire j ou, Dr. Ochsuef, you may not have spoken to such a small group, but you probably have never spoken In such s h-Jitt group. Dr. Ai.io.v Octi-.vjR (O.f.-n-'- foundation. Nvw Oth-ans. Louisiana): Thank you, Mr. ('hatrtnan: It is inuced a pleasure for me (* he here. When !. Olson called me uud asked me if I would tnitc,n( course, i wax very happy to because I am extremely verMl All higher ship there I was that . .ed so can pro- t the Railroad Re- neat and Sickness fTe are going to c insurance. Retirement Board ids. 'Vincut insurance .mv-* mud*1 by I tie .ru i-rm'ti uv<-r the akiin to kr*p c*. us die accomphshuirosd Retirement .it we might hope ' worm. 8 f will ing more to say. lie ai.4 I will be k<?s c.trc ut that a anyone Jesire fnrni Hoard the .a -'ll ti.e job \. \ppluu.-ei ith i-r meeting, .uwiive Factor sor <ii aurgery, Ochsner Clinic arity Hospital; Iwav. :o such & small >up. u, Louisiana!: 'ailed me and 1 am extremely Proceethnya of Medical and Surreal Section. SI grateful to the two railroads with which I am altiliated. I don't know that 1 have much to do with them, but I have enjoyed my affiliation with the Illinois Central and the Southern Pacific. I have been with them /or a number o( years. As many of you know, I have been very iuterested in the question of carci noma of the lung for a long time. My interest was started about twenty-five years ago, and I have had the rather unique experience of probably having seen and operated upon more patients with carcinoma than any other person. The only reason for that is f started my surgical career just at the time when thoracic surgery was being developed. i We know that radioactive 'Uhstanecs produce carcinoma of the lung. As a i matter of fact, tiic tirst evidmue <>i r in moma of the lung was produced by :t carcinogen ww shown in the mines in Sdieh-sia and (.'^clioslovakia where the Schoenberg and the Joaehimstlial miners were found to have a high incidence id the cariconoma of the lung. This is due to radio-active substances, particularly omnium ami cobalt. Chromates are also kuowu to produce carcinoma of the lung, particularly the moDoebromates. In the Coiled States chromates are accepted aa a cause of carcinoma of the lung, although it is not compensable by law. It is in Germany. s There ia very good proof that asbestos is a cause of carcinoma. This is seen I i in individuals working with asbestos, particularly miners. It is also seen among plumbers who work with asbestos, seainlitters, particularly. jii Probably the most important earnuogoiuc agent in lung cancer is cigarette i smoke. It is a known carcinogen, although there are some people who at ill i doubt that there is a cau.-.il rvlation.-hip between smoking and cancer. i The above mentioned factors are proven carcinogen agents, I would like, now, to consider factors in which there is a suggested relationship in that lung cancer occurs with slightly greater frequency among these workers than the general population. i Exposure to certain metals (welders, tor iu>tanc<0, Boiler Scalers, gram duek'-rers (have a higher jundviiec, particularly in Kngiaud). And beryllium workers, i!htu is a xuirge-tivn of a higher incidence of lung j cancer than the general population. Uk.-t furn.ifc/n'.ii, and tcrfi- ularly -:Ud furtri. eii.-n. have been shown by i):< J !|i:ir:<'M.` to have a .r'- vn-r im-.d-iieo of lung c.un:r. \n 1, -tops haw- ( ikrii in previ lit it. U'h'-r occupations are painters and v.u'mdvi*, {'ibncatihg oil workers, afxune worker*. im-kc-I loh.u'co dtamilat itu-rs, lithographic ami pro.-- e->s engraver*, tailors' |.,ri.uig worker*, draper*. bartrmtir*, butchers, uni versity .itatfs, oilier -talf-. mmmvri'ial traveller*. porter*, a ml diamond cu Hers. i i All of the above niem:oru.d occupations have bi-cit mentioned as having a i higher incidence of bronchogenic cancer than the general population, ft is i obvious that few if any of them have anything in common as far aa their oc cupations are concerned. There is only one thing, I think, that thny probably have io common, cigarette smoking. Aside from the first group I gave in which there is a very definite relation ship between the occupation and lung cancer, there is no occupation in which there is apparently a relationship. 1 attempted because I was talking to railroad surgeons to find out if there was any study in which the railroads might be incriminated because I am sure that is the thing you people want to know about. 82 Atiocialwn oj American Railroad* *4 I There ia only oae study that I could find; that was by Heuber who, aa you * know, is a member of our National Health Laboratories and who has done a \ great deal of work oq occupational cancer. 1 Heuber did a study in which he showed there was a higher incidence of cancer 1 among the operating staffs of the railroads than among the nonoperating staffs. But, this was very incomplete because there was nothing in this study y said concerning their smoking habits. Obviously, among the operating staff's 4 at the railroads, there are very few women; moat of them are men. The women are mostly in the offices. I think that that is probably the reason why the incidence of cancer of the lung was higher among the operating 6taff than among the non-operating staffs. I think if the smoking habits were known, it would be shown that the indi viduals who have the cancer -of the lung are smokers. I am convinced that whenever you s.-c cancer of the lime from those working with radio active substances or those working v, ith chromate*, or asbestos, that the indi vidual who develops cancer of tlw lung is probably a very heavy smoker, ami that his rnoking habit is the thing that U responsible, for his cancer and not his occupation. Now. jti-l :i mini .about it,,- im td< n<-- of cancer of the hmu. It is something about wbi'-h 'on and i mn-i be rnitreriu-l. in M:is>:vch'i-Us i-mirer oi ti,,Jung is the nint frequrul ertne-er --f'lp'TM-diiig since [950 even enm-er of th,breast. It increased from 3.0<S per 100,000 iu 1930 to 42.10 in 1055! Cancer of the lung is now the moat frequent visceral cancer in both sexes. It has outstripped everything else. In 1930 twentv-fivc hundred people died of cancer of the lung; in 1956 tweDty-niae thousand died of cancer of the lung. That isn't coincidental. We know that cancer of the lung is much more frequent among men than among womeu. It is thought to be due or said to be due to a sexual relation ship. It isn't at all. Until the mid '30'e the incidence of cancer of the lung was the same in both sexes. About 1934 there was a tremendous increase in cancer of the lung of men, and there lias been a slight increase in the inci dence of cancer of the lung in women. Why is this? In 1914 at the start of the First World War, men began smok ing cigarettes heavily. The twenty-year-long period from the First World War until the mid '30's is Just about the length of time for the cancer-producing affects of cigarette smoking to produce its effects. In New York State where the vital statistics are also valid, from 1931 to 1950 there has been a 3S5 per cent increase in the incidence of cancer of the lung in men. And, during this same period of time, all other cancers increased only two per cent. In women the iiicre.".-- in cancer of t)ic lung was sixty-eight per cent during which time all ,* h-r c.-mri-rs decreased lifti-vn per cent. Cancer of the lung is the only cancer that is increasing in both sexes. This lias been true not only in our own country, but it has been true in other civilised countries where people smoke. In Holland from 1924 to 1951 tliere has been & tenfold increase in the incidence of cancer of the lung in women, and a twenty-four-futd incrco-se in the incidence of cancer of the lung in men. In England from 19JU to 1954 there was a thirty-eight-fuld increase in the incidence of cancer of the lung in men. In fact, , England, 1953, of ail the men who died from nil causes between the ng**s of forty-five and tifty-live, the most productive years of a man's life, ten percent died of cancer of the lung. Th.tween ciden more that; Uniu have years terrif years, ten o: be ai: Ca great great Th lungfifty-: the b- Wj one r heart ti.rui. A c. caocc disea-hi no on It i Ti the k tical. I doc thera wort! Th retro; amoc Th Prnumt term T) sum Sen lii can byt T1 by habi T non ;r who, as you 10 has done a cnee of cancer noo-operating ; in this study .('rating stalls The women :Son why the r.g staff than :hut the indinvinrwi that ; with radio'.sat the indismokcr. and .ncer and not ;s something aflccr of the .tnc*T of the 1 flQtw .ACS. me; in l'J56 ii.-ntaJ. :g men than uai relationr of the lung .jus increase in the ioci- gan iijok- . ir-t \V-r!d r-produi log im vm to .neer ..f the :s ir.ereaoeu .ent during Ci rce iq other i 1051 there : m womeQ, :cg in men. case in the all the men a, the most ? i- TT'3?,V Proceedings of Medical and Surreal Sedion $3 I The statement is frequently made: There can be no causal relationship be- tweeu sraofcing and cancer because, if there were, we should have a higher in cidence of cancer of the lung in the U. S. than m England because we smoke more than the English. This is a truth, but it i9 only a half truth. It is true that the incidence in cancer of the lung is higher ia England than here in the United States, and it is true that we smoke more than the British do. But, we have smoked more than the British only for the past nine years. Prior to nine years ago, they smoked much more than we; and they are now paying the terrific price for their tremendous smoking for the past twenty-five and thirty years. It is frightening to me to think what is going to happen to us in another ten or fifteen years when our smoking habits catch up with us. It is going to be almost a catastrophe. Cancer is a disease of older age; of all the persous uinety years of age, a greater percentage will have cancer than those eighty. Of those eighty, a greater percentage will have cancer than those seventy, and so on. This is true of every cancer except one. The one exception is cancer of the lung. Cancer of the lung increases very 3barply to reach a peak at the age of fifty-five following which with advancing age, there ia a decrease. Cancer of the lung is the only cancer that doesn't follow the pattern of all other cancers. Why docs it behave differently? It behaves differently for one reason, and one reason only: The individuals who have smoked heavily and subjected their heart and blood vessels to the deleterious affects of tobacco, develop coronary thrombosis, die and don't live long enough to develop cancer of the lung. .V dubious advantage of smoking, therefore, is that one can spare himself a canccr-of-thc-Iung death by -rooking heavily and dying early of coronary .linear. (Jne might carry analogy a 1 it tic further and say that one might .-pare himself a death from both these causes by -hooting luroself at forty which no one would suggest, of course. It is a slow form of suicide, but it is just as certain as shooting ones self. i There have been .-cvral .-fanatical .-tudies made, which Pr. Little who is ihe Chairman *>f the Tobacco ('tmeiU.v otilwagcs because they arc >!atis- tical. The baris of all our knowledge is statistics and everything in medicine, I don't have to tell you, is ba.-od upon .-uiistics, ultimately. I am sure that * be f :ulr" els are run by .i.,i i in iK - s. To poo-poo .-tati.-tii's ns not being 'ortif.viiile. is .-imply d< umg : hiMpi' -lion. TJ.r.M are two tvp-'s ,,i' -tnu-ucal >:udi s in a problem Mich m this: One is retro>p:clive, which coa-.-sts f tie* determination of the uurober of smokers i among a group of patients wirh cancer. There is some criticism to this method because it is a selected group. Prospective studies con.-ist of determining the .-moking habits of a large number of individuals and following them for a number of years and de termining what happens to them. There is no selection here. There are two studies which have been reported so far. A third one, i under stand, is to be reported very soon- That is being carried out by the Veterans' Service. ` But the two that I want to speak about today, one was done by the Ameri can Cancer Society here in the United States, and the other done in England by two physicians, Doll and Hill. The British study was concerned with the medical profession. It was done by having the physicians fill out a questionnaire concerning their smoking habits and then following them. And, this is the result of that study. The incidence of cancer of the lung per hundred thousand population, in the non-scaokers was eevea; in the pipe smokers, thirty-eight; in the pipe i r 84 Association of American Railroads cigarette smokers, sixty-eight; and the cigarette smokers, & pack or more a day, 125. This study shows that there is a relationship between smoking and cancer. It further shows that not ooly was there a relationship, but the relationship varied according to the amount smoked; the non-smokers seven; up to fourteen cigarettes a day, forty-seven; from hfteen to twenty-four cigarettes a day, eighty-six; and more than twenty-five cigarettes a day, 1116. It is almost like a mileage figure. One can determine how soon one wants to develop cancer of the lung by the amount that he smokes. If he doesn't want to develop it at all, don't smoke as I don't. If he wants to develop it soon, smoke heavily, fit-cause he i? going to develop it soon. I am frc'pioTiMv >>!<!: Weil, it won't : > me any good because I have smoked too long, and I he die ha- ixt-it ca>t. ] Jr. Graham .said this several yearn ago and he used to chide lie' about my belief coiK'erning the relationship of smoking to cancer. Ilut then l..; t,. ca:ne ronvintvJ that in* re was, and he became quite intolerant \>i the jd< who finok<- i. Tin- tragic fact i.- that Dr. Graham who did the fir.-i sun <>-fid pjii-uiuouectomy for cancer of the lung died of cancer of lie lung him--:f. It Lb not tiveesomniy true that the heavy smoker is doomed and that he* can't be benefited if fie Mop.- liccaus'o the pro-cancerous changes 8re reversible we know now. And the studies bv Doll and Hill show it. They show that in those that continued smoking, the incidence of cancer of the lung was 103; in those that discontinued smoking, but had discontinued less than ten years, it was fifty-nine; in those who had discontinued over ten years, it was thirtythree; as contrasted with seven iu which the group had never smoked. The American Cancer Society study consisted of twenty-two thousand voluntary workers, young workers in the United States, Interviewing two hundred thousand men between the ages of fifty and seventy. These are the ages of which cancer of the lung are found. Those young ladies had each of the men fill out an elaborate questionnaire concerning their smoking habits: whether they smoked at all, what they smoked, how long they had smoked, how much they had smoked, and if they have ever stopped. These quesuonoariea were filed at the Cancer Society Headquarters, and each year each of the young ladies reinterviewod each of the men whom she had interviewed Use year before. Then* was almost a ninety-nine per cent foilow-up. After a six-year period of time, a little ovr-r twelve thousand men bad died. In those that died, she got a photo.r.-xt of the deaili certificate and sent it to the Dancer Society Headquarters, b (hev had died of cancer and had an aup-psv or biopsy, the got a pi<cr of the tu-.xie. nod sent that in to the Cancer Society. The results of this study showed that the overall death rate was 105`o higher among cigarette smokers than non-smokers; the death rate from heart disease was 115Sc higher among cigarette smokers than among non-smokers; and, the death rate from luug cancer was SOOco higher among cigarette smokers than among non-smokers. I have yet to see the physician who doubts that there is a relationship except two individuals: One is an individual who is an employe of the tobacco com panies, and the other individual is the individual who is addicted to tobacco liiiuxdf. Naturally, i am going to try to excuse that which I do. I am not willing to admit that any tiling I do is harmful to oie. xU'-Ah- Several y. of the Amer. can be no c were, wbv c Of course, talked to D. about it. H then started the name o membrane c smokers--ti leading to r Wc have sumption it. whereas, in dropped dou There i* fonsumplK-i Many mm States, only arc women. Smoking fifteen, indu from sixteen Dr. Grata: tween smokiwork showing They used smoked sixt) a drag for t* residue was this comnina three times At the ei of applicati site of the of the ania was iod>.-U the animal la the cc at the cad I eroph Dr. Graha He did Dot The eta1 cancer witl tion. It producing Since wi cancer, thi there is a know thet u cts, a pack or more a u -smoking and cancer. :p, but the relationship rs seven; up to fourteen four cigarettes 3 clay, . JOG. '.e how -on one wants maVs. U he doesa't :.e wains to di-wlop it Mlfl. i iT!ius<r I have smoked : \ several years ago and -uonsbip of smoking to -!. and he became quite i coat Dr. Graham who he lung died of cancer < doomi il and that he j changes art* reversible - it. They show that in .ft; "r waa 103; in i !' ten years, n yr-stra, !t was thirty.i:vcr smoked, v.vrtuv-two thousand ktes, interviewing two venty. These are the : boratc questionnaire xl at all, wliat they . i ?:Wscd, and it they v H>- ..i-juartt-rs, and f r:.u-a wuom ibe . ninety-nine per cent oniand men had died, r'.jtivivte and sent it to .; ijucer and had an that in to the Cancer : rate was 105 ?o higher .lie from heart disease rain-smokers; and, the garette smokers than :s a relationship except of the tobacco com* . < addicted to tobacco . rich I do. I am not I Proceedings of Medical and Surgical Section 85 Several years ago while attending a Cancer of the Lung Committee meeting of the American Cancer Society, I was distressed because someone said, "There can be no causal relation-hip between smoking and cancer hecaure, if there w*re, why do we not .-if! pre-eiiun.TOus le.-ions?" Of course, not being a pathologist, I couldn't answer this. I came home and talked to Dr. Dunlap, uur Professor of Pathology at Tulane, and naked him about it. lie thought for a moment, lie said, "We don't look for it." They then started one of our senior students on a piece of investigation, a man by the name of Costello. This work demonstrated that although the mucous membrane of the tubes was normal in non-smokers, definite changes occurred in smokers --they -.v.-re moat marked in heavy smokers with precancerous changes leading to cancer. We have become a cigarette-smoking nation. In 1SS0 the per capita con sumption ia all persons uueen years of age and over, annual, was sixteen; whereas, in 1953, it was 3,556. The uuiy solace one gets is that ia 1956 it bad dropped down to 3,193. There is a parallelism between the incidence of cancer of the lung and the consumption of cigarettes. Many more men smoke than women. Among the non-smokers in the United States, only twenty-three per cent of them are men, and sixty-seven per cent are women. Smoking is common among teenagers. Of the teenagers from thirteen to fifteen, inclusive, thirty-seven per cent smoke at the present time. Of those from sixteen to nineteen, inclusive, sixty-^ven per cent smoke. Dr. Graham who originally thought there was no causal p-latinnsJiip be tween smoking and cancer bnally with Dr. Wiugncf did the most conclusive work showing that there was a carcinogcu in the smoking of cigarettes. t They used a smoking machine which looks like a giant candelabra. It smoked sixty cigarettes at a time, juit tvs a human would. Every sixty seconds a drag for two seconds was taken. TV .-moke was eollcct.-d, cnnlcd and u Ur residue was obtained. The tarred n-iduc was* added to a solvent acetone and this combination of the tur and acetone was applied to the rkin of aaimals i three times a week. At the cud oi euiht mooiiis, '!(. cujih uin'.erMt,4 tumor l<-.v< l..ui 'l -.t 'be .-ite of application of the tar. At the ml <.f:% \i ar, mu: real calker developed .it the site of the application of the f ar. \i the --id i .m yearj. lor' v-rour ;--r c-nt of the twiinmta developed ;*t tin: mU: <>i appuc iimu of tile lar a eaucer which was indistinguishable from human cancer in that it metastasized ami killed the animals. In the control group to which only the. solvent w.u applied, not one auiinai j at the end of two years developed either a non-cancerous or cancerous tumor. ,. I emphasize this latter part because the statement is frequently made that Dr. Graham's work is of no value because he used cancer susceptible animals. . He did not, because in the control group, not one animal developed cancer.. ^ The statement is also frequently made that one cannot compare animal j.V- eaacer with human cancer. Mo attempt is made to do so in ibis expenmenta! ' y tion. It simply shows there is, without any question of a doubt, a cancorI Producing agent in the smoke from cigarettes. ! * Since we know that cancer of the lung is increasing more than aay other i cancer, that it is the most frequent visceral cancer today, and ainre wo know i - *?? there ia a cancer producing agent in the smoko from cigaruttes, and since we. > .know there is a parallelism between the consumption of cigarettes the J f l M.aiSrueTi i . rt \ -Ct .`tcV-- 88 Association of American Railroad* incidence of cancer of the lung, the only logical conclusion ia there is a causal relationship. I am frequently asked if filters help. I always answer in the affirmative. They help sell more cigarettes. That is all they do. In 1954 we spent per capita in the United States eight cents for the control of heart disease, and we spent fourteen cents for the control of cancer. We spent twenty-two cents per capita to contTol the two principal killers. During the earoe time we spent thirty dollars per capita for cigarettes. In other words, we spent 136 times as much to cause or aggravate the two principal killers as we did to prevent them. The British arc more courageous than we. The following i^ the inscription via large yellow posters --displayed in all public places in England. "To all smokers: "Th'-fx- an* non the strongest reasons to believe that smokers, par ticularly of cigarettes, run a greater ri.4: of lung cancer than non-smnk-r; the Inure cigafrl m- con-iu/i."i. the gr.-:j--r the risk." / mention tins t . >t,,,w lie- courage that the British * iovcrmuMil has in posting in ali public places this poster. It shows that they have assumed the obligation which I think government should. 1 am sure what I have said to you isn't going to make any difference io your smoking habits, but I hope that whoa and if anybody makes a claim against any of your railroads because of cancer of the lung, they have gotten oo the job, that you go aud find out what their smoking habits are- If they have an adenocarcinoma, it lias not been produced by smoking because it is not related to smoking. I believe that smoking is the most valuable diagnostic criteria we have as far as carcinoma of the lung is concerned. Six years ago I made the statement that any person who has a lesion of the lung that might be cancer, if they do not scuoke, it is either not cancer or it is an adenocarcinoma. In the six years, I have been wrong only twice. There is no other diagnostic criteria that is that accurate. Whenever a claim is made against the railroad because a patient has de veloped carcinoma of the lung, inquire into bis smoking habits. And, I&an assure you that man. if he has an epidermoid or undifferentiated carcinoma, which he ia most likely to have Imthuw ndeunrarnuomu is rare (only uhuut twelve per cent of all carcinomas among adenocarcinoma', has bi-eu a heavy smoker. He may not U- a i-moki-r at that time. But, he will Lave been a heavy smoker, and ] can assure you that Lis rancor of the lung has been pro duced by Lis smoking and not by Lis occupation. I would urge 11.>>.-< of yvu who trcal patients and thn>r of \ mi win, smoke to have a che4 plate done at lra>t every m\ months .-<> when you do develop cancer, it can bo detected at a time while it is still ofierublc. Because I am just as convinced as I am standing here, if you don't die of something ti>e first, you are going to develop earner of the lung. The only thing that will save you is that you might die of something else. Thank you very much. (Applause) Dr. I. GoLDOWssr: Thank you very much, Dr. Ochsoer, I think it is a pleasure for our group to bear that there is one illness not blamed on the rail road industry. 1 think we have been blamed for most everything else and have suits and claims against us. I thir your talk. Are t Haris. Mb. chromat Chroform as the oUr Can of the 1 Dr. nii'>ni., 1 As i; highr.tr. His and in Mr. Dr. I ha inonocnr He Io* Da. lung, soon a As. Littie man. snppo Vs the ca Dr the I( Tl tine much Th. Gicot is there is a causal in the affirmative. at3 for the control roi of cancer. We ,>oJ killers. Duriog ft. In other words, principal killers os < is the inscription ; gland. hat smokers, parhta non-smokers; h Government haa zey have assumed difference in your ..a r '' -ira against iv( on the If v. j have an ,_-e it is uot related .iagnoatic criteria has a lerioo of the not cancer or it ia . j other diagnostic v p.itk-ut has de. us. And, I can , vtcd rarciaoma, fvN: >o:ily about .as l'en a heavy .rill have been a ..'jig has been pro- "jU who smoke to t, you do develop <v Because I am A something else ,y thing that will r. I think it is a .vised on the rail ing else and have 1 ] 1 ; ' ; j j i ; 'A1 Proceedings of Medical and Surgical Section 87 I think it is a compliment to your crusading spirit that I cast my eye over your audience, and I didn't see a cigarette being lighted during vour whole talk. Aro there any questions from the floor? Harian Hackbcrt. Mr. Hackbert: I would like to ask the Doctor about the incidence of chromates and carcinoma of the lung. Chromates are u.-<*d in the railroad industry in two forms;one in a powdered form as it is used in mixing cooling solution used in the diesel locomotives; and tin* other as the chromato ii found in the cooling solution. C`au you tell us something about the manner in which chromates affect cancer of the lung? Dr. Alton Ochsneb: I have had no experience with chromates or car cinoma of the lungs produced by chromates at all. I can only give you what I have gotten from my reading. As far as I can determine, it is found only in individuals working with a very high atmosphere of chromates, sDd then only monochromates. It is not extremely common, but I think it is found only in where it is mined and in the factories; that is as far as I have been able to determine. Mr. Hackbert: In the production rather than the use? Dr. Alton Oc usner: In the production of it. 1 have never found anyone calling attention to the fact in its use. monochromate that is responsible; I think everyone ia agreed to that. It is a Unidentified Voice: Am I right in that Dr. Little of Bar Harbor is being discredited at this lime; he is not a ciiniciaa. He ia only a laboratory man. He lust his first mice in the tire up there, but bis work was based wholly on laboratory and not on clinical findings? Dr. Alton Ocilsner: Dr. Little has done no work at all on cancer of the lung. He knows nothing about cancer of the lung. I doubt that he has ever seen a case. Aft you said, he is not a phyririan. JfoisaUh. D. He is a geneticist. Dr. Little is talking about something he knows nothing about- He is the front man. He is paid a salary of twenty-five thousand dollars, and, of course, I suppose persons will do a lot for twv.nty-tivc thousand dollars. Unidentified Voice: Dr. Ochancr, what possibility exists for removing the carcinogenic factor from tobacco? What is being done along that line? Dr. Alton Ochsneb: Of course, that is the thing that distresses me about . the tobacco people. I feel that something can be done. There are two factors in tobacco which are harmful: One is nicotine. Nieo tine produces heart disease. There isn't any question about that. There are available today nicotine-free tobaccos. Those are not the so-called donicotioized cigarettes. Because, the denicotinized cigarettes have almost as much nicotine as do the other cigarettes. The deniootini2ed cigarette* advertise they have lese than one per cent nicotine, implying they have removed ninety-nine per cent of the nicotine. " '{&%* The average cigarette has only about ooe per oeat. They have removed so little, it actually makes no difference. But, there are available today, which can be grown, tobaccos which have no nicotines at all. The thing that causes cancer is not nicotine; it is tar. Whether this car cinogen can be removed or not, I don't know. I think it possibly can. But, there has been no attempt to do so; that is the thing that distresses me. There has been no attempt to do it. They haven't assumed any obligation at all. The industry and their Kcs'-arch Comrniite** have spent their money trying to confute the issue. For instance, they are trying to blame it on araog. One might accept smog. For instance, they say the reason for lb*- high incidence in londou is because of smog. Tb-re ia u terrific tm<>g in London, as everyone knows. But, im mediately acro.-s the iJmdish ("haiinr-l in Denmark about thirty miles away where the people s-m"l;e the "tnie ns th.-v do in linytan* l and where* the incidence, of cancer i- tin s;sn>- n- n i- m hngland bis a cuatu-r of fact, it has assumed epidemic projwrtiotw in iVnm.irkl, there i no smog whatsoever. The inci dence of canevr of the lung j.** higher in N*w Orleans than it ia to any other city. New Orleans is first; Pittsburgh, eighth. Now, you might ask me why. Tim reason is in New Orleans for years people have smoked these Picayune cigarettes. For those of you who don't know what a Picayune cigarette is, it is a very strong cigarette. The final reason why smog has nothing to do with it is that if .smog had something to do with it, women ought to have the same incidence. We always admit that their minds are purer than oure, but they breathe the same putrid air we do. The reason is the man-made smog that he himself takes in; and I believe that this thing can be solved. I think they ought to be spending their money, a part of that hundred million dollars that they are spending, for advertising, trying to find out what this thing is and giving those of you who have the infantile urge, the suckling reflex, a cigarette that ia safe. That is all it is. Unidentwed Voice: Why the difference between cigar smoking and cigarettes? Dtt Autos Ociisseb: There are several reasons: One is that the cigar smoker doesn't smoke as much. The cigar smoker docs not inhale. Ooe roust get the carcinoiren in coaiuct with tin* tissue to produce cancer. There is a third reason which tin* tobacco people have not made use of. I suppose they won't because of the cost. The third reason is that there is leas of the noxious alkaloids in cigars than the other tobaccos because of the way in which it is cured. You people who come from the tobacco areas know more about this than I. The tobaccos for cigars are what they call ''shed cured." The leaf is picked, and it is kept in a shed for many years. I happen to know the man who makes the King Edward Cigar, winch you know ia a cheap cigar. They keep the tobacco for the King Edward Cigar for three years. This is kept at room temperature. , As a result, there i* an enzymatic process which occurs in the leaf which tends to break down nicotine and other alkaloids. All the other tobaccos are picked, put in the shed and heated to 140 degrees. That immediately stops the enzymatic process. That is tho reason why the <\ \v u u.,_ ** * Mil,, ^twt, * U*lu, thou, | theiu Mb ]>.. The Perrlvbj &n. their .{ ia a Itw i 1 hu I >U`), eitr*/i*. 1 u... Bj. 4 wo>J j D* / cit 1 au. ti at u. If w L., ju* J of owta- Dnu La. a. X id* . They have removed so .i, tobaccos which have no i tar. Whether this carink it {xiesibly can. But, ' bat distresses me. There any obligation at all. -pent their money trying Ouc might accept smog. tco in Ixindon is because ryone knows. But, iraabout thirty miles away d and where the incidence r of fact, it has assumed g whatsoever. The iocihan It is in any other city. * Orleans foe years people - of you who don't know tte h' t if smog had me inciocuce. We always , breathe the same putrid ikes in; and I believe that spending their money, a pending, for advertising, :*e of you who have the safe. 'u .agar smoking and One is that the cigar "* not inhale. One must -luce cancer. There is a i.j u.-*o of. 1 suppose they !vre is lees of the noxious oi the way io which it is more about this than I. red.1' The leaf is picked, mow the man who makes p cigar. They keep the t. This is kept at room occurs in the leaf which ad heated to 140 degrees, at ` ason why tha Proceeding* of Medical and Surgical Section 89 cigar tobacco actually has fewer of the noxious substances than do all the other types. Unidentified Voice: What percentage have you operated on that did ot smoke? Dr. Alton Ociisnek: Those of the jwrsoiuj that had an epidermoid or undifferentiating carcinoma, ninety-eight and a half per cent were cigarette smokers. Mr. If ai.rukut: You .-peak of tars carcinogenic factor; that term doesn't mean much to me. I happen to he a lawyer, not a 'Wtor like the rc-| ot yon here. In what other substances arc we going to find that same tar element/ In other words, what other caudal factors may the railroad look to as being a possible cause of inhalation causing lung cancers? Da. Alton Ocusner: Well, I suppose there are other areas; but as I tried to bring out this morning, I explored all these areas, and could find none cf them. 1 gave you here those occupations in which it was admitted there was a causal relationship, those factors. Then I gave you twenty-odd of where there had been a supposed increase. There is not a thing in common between them. Mr. IIackbekt: What other substances have tho tar in them? Da. Alton Ochsner; There are many carcinogens. The first carcinogen we knew was coai tar. The chimney-sweep type which Percival Pott described two or three hundred years ago is a type of tar cancer. Some of the textile workers devidujjcd carcinoma of the genitalia because their clothes became impregnated with oil if they didn't keep clean. Hut, that is a lack of cleanliness, and so it is with chimney-sweep cancer. There are many cancer-producing agents. [ didn't go into this, but tlwco are a number of carcmogcus that have been extracted from tar. I think what tin; indu-irv ought to do i* to find out what tln-<- im p.rs are and remove them, which r! *-v arc not doing now. Dr. J. K. Knowlka: The lead put m the paper to produce blow burning would have absolutely nothing to do with it at all; would it? Dr. Alton Ocusner: I don't think so. I ara convinced there ia a car cinogen in tobacco itself. I am sure some of you, as we do here in Xew Orleans, see a rather large number of people that have a smut cancer. Sow, smuT, of course, isn't burnt at ail. It is put in the mouth. The most vicious type of cancer we can get. If one finds a very small lesion, we havo to do a very wide excision. That is just pure tobacco. It is not burned at all. f I think the carcinogen is in the tobacco. I don't think it is just & product of combustion. Umdentitteo Voice: Hnuff cancer is seen in the noee, as well; isn't it? Da. Alton Ochsneb: That is right 00 Attocialion of American RaUroodt Da. I. Goldowskt: Thank you again. (Applause) I am going to take the liberty at this time to take a minute or two of Dr. Ochener'e time to maybe expound a little more on the chromates aa a cause of cancer of the lung. Twenty-five years ago I was associated with the chrocoe industry in Jersey City, and the Mutual Chemical Company of America and its manufacturers. 2 wasn't loDg with the company wheo it was my unfortunate experience to run into a small epidemic of carcinoma of the lung. I started delving into the literature. About that time, about the only thing I came up with, os Or. Ochnser has told you, was in Germany it was compensable. Wc had three problems which I had to face as a physician with the chro mates, that was the chrome sores that hit these men. The amount of chro mates they used iu the glass industry, they developed real chrome holes that used to look like a collar button hole. It was a fine hole, and thru it would branch out into a collar button. You realty had to scrajx- them out, dig them out, to get them cleaned up. But, in my years with them, we never ran into anv carcinoma of the skin as a result of the chrome sores. Again, we had the chrome hole.- iu the nasal srptums. It didn't take more than about four months of a roan's known employment with our company Indore he had no septum left. That stud is better than any ear, nose ami throat man can do. It really tore a hole through them. As far as the carcinoma of the lunge, I think to expound further, in Germany it was compensable. They found that tliis type of cancer produced by the monochromates was a slow-forming cancer. I think it was recognized only in the compensation cases that a man had to be employed in the Schnccbcrg mines at least twenty years. If they wore employed two or three years, it wasn't recognized as an early form of cancer. I don't know if that will help you in your problem. I know it is a dichromate in the chrome you are concerned with the compounds that were used. Wc merely have trouble as far as claims, but we are going to leave it to you lawyers to defend them. Xow, if you will just besr with me a few minutes, we are going to finish this tbree-day session. Dr. Graham bad to leave, but be left me a report that he had that he would like to have read: "Mr. Chairman and Members of the Section: "Several changes in the organizational setup of the Joint Committee on Railway Salutation have occurred iu the past year, which arc reported to you as a matter of interest. "The Joint Committee's brief summary rejKirt for the year 1957 wn- included as a paragraph in the Medical and Surgical Section Annual Report for the Association. "As many of you know the Sanitation Research Committee of the A.A.R. Research Laboratory in Chicago was started in 1951 on the recom mendation of the Joint Committee and placed under its jurisdiction. In December, 1957, by action of the A.A.R. Board of Directors, Mr. \V. M. Keiler, formerly Director ot Research m llie Mechanical Division of the A.A.R. was apjKiinted to be Vice-President ot Research iu the Operations and Maintenance Department of the A.A.R. and to have supervision of research in that department, including the olhce of .Sanitation, Research and Development. Ptoc* "The Joint Co: and be called on sanitation rescarc: "It is contemp: to exhibit an jntc and work jointly "R. M. Graha Sanitation." I don't have a quor; ing. Do we have any un: Dr. C. F. Holton : rt rfteTa. . . . The motion wa Dn. I. Goldowski the hotel that helped Is there anv moti'v . . . The motion v journed.. . . Da. I. Goldowsei Eighth Annual Mce: adjourned. While 1 have a lit t: 'til we meet next year ... Whereupon, the r.t two of Dr. -.< 3 as & cause -try in Jersey anufacturera. experience to .ving into the with, as Dr. ;th the ciiro.<mt <*i chro- holed that .cii it would tt, dig them a of the skin j in the nasal ion's known that stuff in :>oic through ''ty ~TMy iX he vnizcu only ."chncebcrg roe years, it h iliehronmte e used. Wo ve it to you '.o finish this at he would .mmitiee on re reported ir l'J57 was moo Annual utce of the .: he recomiiciioo. In Mr. W. M. tsiuo of the Operations iH.rvwion of i, lb-search Proceedings of Medical and Surgical Seaton 91 "The Joint Committee will continue to report to Vice-President May and be called on to offer suggestions to Mr. KelJer on the problems of sanitation research. "It 13 contemplated that the Medical and Surgical Section will continue to exhibit an interest in matters relating to railroad sanitation problems and work jointly with the United States Public Health Service/' "R. M. Graham, Chairman, A.A.R. Joint Committee on Railway Sanitation." I don't have a quorum prrseut. I don't even know if I can close this meet ing. Do we have any nnfini.-lied business? Id there any now business? 1 >k. (J. 1'. IIulto.v: 1 move the wce.-sary thanks l>c extended to the hotel, el cetera. , . . The motion was duly seconded. . . , Dr. I. Goldowsky: Moved and seconded everybody be thanked around the hotel that helped us. Is there any motion for adjournment? . . . The motion was made and duly seconded that the meeting be ad journed. ... Dr. I. Goldowsrt: It has been moved and seconded that the ThirtyKightb Annual Meeting of the Medical-Surgical Section of the A.A.R. bo adjourned. While l have a little speaking voice lent, l hereby say "goodbye, God speed 'til wc meet next year." ... Whereupon, the meeting was then adjourned.... 1 J i I ;? 'i i 4 1 A. 92 Auodaiion of American Railroad* OFFICERS AND PERSONNEL OF COMMITTEES OF THE MEDICAL AND SURGICAL SECTION FOR THE YEAR 1658-1969 j Dr. B. W. Stockwvll, Chairman Dr- J. K. Stack, Vice-Chairman F, J. Parker, Secretary Committee oi Direction Dr. B. W. Stockwell, Chairman Dr. J. K. Stack. Vice-Chairman (Term expires in 1959) Dr. M. B. Clayton. Chief Surgeon, Southern Railway System, 15th and K Streets, X. W., Wjtr-hingfrm, D. C. Dr. h`. fh D<>d, ('l.i< f .M- Jif-nl Otiicer, Canadian National ItaihvuvH, Montreal, Qm-. Canada. Dr. V. \V. Hollo, Chief Surgeon, St. J-ouia-Sau Francisco Railway, St. Louis, Missouri. Dr. J. Iluber Wagner, Chief Surgeon, Bessemer & Lake Erie Railroad, 525 William Penn Place, Pittsburgh, Pennsylvania. (Term expires in 1960) Dr. R. J. Bennett, Chief Surgeon, Elgin, Joliet and Eastern Railway, 208 South LaSalle St., Chicago, Illinois. Dr. I. Goldowsky, Medical Director, Central Railroad Company of New Jersey, Jersey City, New Jersey. Dr. W. E. Mishler, Chief Surgeon, Erie Railroad, 608 Republic Building, Cleveland 15, Ohio. 5 Dr. D. TV. Stockwell, Chief Surgeon, Detroit and Toledo Shore line Railroad, 3919 John R. .Street, Detroit 1, Michigan. (Term expires in 1961) Dr. it. M. Graham, Director, Department of Medicine and Sanitation, The Pullman Company, Jthr North Canal Street, Chicago IT, Itlinoid, Dr. Southgute Leigh, Jr., Chief Surgeon, Seaboard Air line Railroad, P. O.Box 1620. Hi'-ltmond 13, Virginia. Dr. Harvey Nelvm, (`hid Surgeon, Son Line Railroad, 1-153 Medical Arts Building. Minneapolis 2, Minnesota. Dr J. K. Slack, Chief Surgeon, Chicago ami North Western Railway, 127 North Clinton Street, Chicugo 6, Illinois. Committee on Disability and Rehabilitation Dr. James K. Stark (Chairman), Chief Surgeon, Chicago <fc North Western Railway, 127 North Clinton Street, Chicago 6, Illinois. Dr. J. F. DePrw, Chief Surgeon (Lines West), Chicago, Milwaukee, St. Paul Pacific Railroad, Hi.V> Medical and Dental Bldg., Seattle 1, Washington. Dr. J. W. Hunk, Medical Director, New York, Chicago St. Louis Railroad, Terminal Tower, Cleveland l, Ohio. Dr. R. A. Johnsou, Medical Director, New York Central System, Michigan Central Depot, Detroit 16, Michigan. Dr. XL 8. Kic Miaaoun Dr. Harvey . Building Dr. G. Dark Windsor Dr. SouthgatRailroad, Dr. Pw G. Car Railway, Dr. Duncan lv 2GUI lla\ i Dr. J. R. Can . Texas. Dr. C. P. 11.,: Gi*orgia. Dr. R. Houeeh. Itaiiroad, l Dr. W. E. MiClereiand i Committee Dr. TV. J. Long, way,520 M Dr. J. J. Brandi. Huntington Dr. B. I. Dora Minnesota. Dr. J. K. Kno Massachu"C: Dr. J. M. L. Jen.' Chicago, Ilii Dr. It. S. WcKiii Wen 03rd S Commit! Dr. it. M.Graha tioti. Tin- Pi Dr. M. B. Clayi Street*, N. \\ Dr. K. E. Dow Montreal, Qt Dr. E. C. OUoo Stony Island Dr. K. E. Dow Montreal, Q Dr. V. W. Hollo, Missouri. i OF THE AR 136&-1969 'in, 15th and K .tonal Railways, .'way, St. Louis, :ie Railroad, 525 r :,-ay, 208 mpaoj of New public Building, re f ine Railroad, . ~ Uii'.Mion. The . is. V. O.lJox Vf Medical Arts ro Railway, 127 i c North Western ,iukee, St. Paul 4 tf 1, Washington. I>juis Railroad, vstetn, Michigan ; i ' i I i ! I j | I l , j I ! i 1 i ! I ' j '' Proceedin')* of Medical and Surqicnl Section 93 Dr. R. S. Kie/Tcr, Chief Surgeon, Miosouri-Kansaa-Tcxas Railroad, St. Louis l, Missouri. Dr. Harvey Nelson, Chief Surgeon, Soo Line Railroad, 1453 Medical Arts Building, Minneapolis 2, Minnesota. Dr. 0. Earle Wight, Chief of Medical Services, Canadian Pacific Railway, Windsor citation, Montreal, Que., Canada. Committee on Trauma Dr. Southgate Leigh, Jr. (Chairman), Chief Surgeon, Seaboard Air Line Railroad, P. O. Box 1020, Richmond 13, Virginia. Dr. R. G. Carothen, Cbirf Sun-gon, Cincinnati, Now Orleans *4 Texas Pacific Railway, < 'iririmiriti J, Ohio. Ur. I )imc:tii 1('lii.-f Surgi-uti, N.i.^hville, t 'huttanooga A St. Louis Kail way, 2001 Haves .Street. Nashville 4, Tcncifysee. Ur. J. It. dandy. Chief Surgeon, 'IVxa* .4 New Orleans Uuilroud, Houston t, Texas. Dr. C. F. Holton, Chief Surgeon, Central of Georgia Railway, Savannah, Georgia. Dr. R. Householder, Chief Surgeon, Chicago, Milwaukee, St. Paul & Pacific Railroad, Union Station, Chicago 0, Illinois. Dr. W. E. Mishler, Chief Surgeon, Erie Railroad, 608 Republic Building, Cleveland 15, Ohio. Committee on Developments Resulting from Physical Examinations Dr. W. J. Lougeway (Chairman), Chief Surgeon, Colorado A Southern Railway, 520 Metropolitan Building, Denver, Colorado. Dr. J. J. Bruodubur, Chief Medical Examiner, Chesapeake A Ohio Railway, Huntington, 'Wet Virginia. Dr. B. I. Derauf, Chief Surgeon, Northern Pacific Railway, St. Paul 1, Minnesota. Dr. J. R. Knowles, Chief Surgeon, Boston A Maine Railroad, Boston, Ma^achu.^etts. Dr. J. M. L. Jensen, Chief Surgeon, Chicago, Rock Idland A Pacific Railroad, Chicago, Illinois. Dr. R. S. Wentline, Chief Surgeon, Chicago A Eastern Illinois Railroad, 334 Wert 63rd Street, Chicago, Illinois. Committee on Medical Aspects of Air Conditioning of Cars Dr. It. M. Graham (Chairman', Director, Department of Medicioe and Sanitatiou, Thu Pullman Company, Hi5 North Canal Street, Chicago 6, Illinois. Dr. M. B. Clayton, Chief Surgeon, Southern Railway System, 15th and K. Streets, X. W., Washington 13, D. C. Dr. K. E. Dowd, Chief Medical Officer, Canadian National Railways, Montreal, Que., Canada. Committee on First Aid , Dr. E. C. Olson (Chairman), Chief Surgeon, Illinois Central Railroad, 5800' Stooy Island Avenue, Chicago, Illinois, Dr. K. E. Dowd, Chief Medical Officer, Canadian National Railways, Montreal, Que., Canada. Dr. V. W. Hollo, Chief Surgeon, St. Louis-Sao Francisco Railway, St. Louis, Missouri. (rr. Timm;; jL .r.^n ^s 1 4 i j i 1 | 1 4 A 4 94 Association of American Railroads Representatives of the Medical and Surgical Section on the Joint Committee on Railway Sanitation "43 4 Dr. R. M. Graham (Chairman, Joint Committee on Railway Sanitation), I Director, Department of Medicine and Sanitation, The Pullman Com pany, 1G5 North Canal Street, Chicago, Illinois. Dr. M. B. Clayton, Chief Surgeon, Southern Railway System, 15th and K. l Streets, N. W,, Washington 13, D. C. Dr. A. M. W. Hursh, Medical Director, Pennsylvania Railroad, 15 North 32nd Street, Philadelphia 4, Pennsylvania. Representatives of the Medical and Surgical Section on the Special Medical-Legal Research Committee Dr. W. E. Miohicr (Chairman), CUcf Surgeon, Erie Railroad, GOX Republic Building, Cleveland 15, Ohio. Dr. R. J. Bennett, Chief Surgeon. Elgin, Joiir-t und Eastern Railway, 20S South LaSalle Street, CJiie::g'>. Ulm'-i.-. Dr. I. Goldoweky, Medical Director, Central Railroad of New Jersey, Jersey City, New Jersey. Dr. Harvey Nelson, Chief Surgeon, Soo Line Railroad, 1453 Medical Arts Building, Minneapolis 2, Minnesota.