his second duty is toward the railroad company he represents, but his whole duty is to himself. No man can afford to impeach his integrity, his probity, or reputation for truth and veracity for any railroad company living. A man cannot afford to sacrifice his integrity for railroads or anybody else. He should tell the truth at all times, whether for or against the railroad company or the patient. The legal department of my road asks nothing else.

A few days ago we had a case in Ohio and wanted testimony from an expert oculist. I referred two or three oculists to the general counsel of the road. The general counsel called in one oculist, who said to him: "What kind of testimony do you want?" And the general counsel replied to him: "I don't want any testimony from you." The general counsel and legal departments of all our railroads want nothing from the railroad surgeons except the exact truth. I would never put one of my surgeons on the witness-stand as an expert, for the simple reason that I have too much respect for him to be browbeaten by ordinary lawyers, who are very likely to impugn the motives and integrity of a surgeon on account of his relations and services to the railroad company that he represents. We can get experts from the outside and our local railroad surgeons should only testify to matters of fact with which they are cognizant, and that is all they should be asked to testify to.

There is one thing which I think ought to be cut out of every report of an injured person, and that is we should not accept or take every statement from an injured party. In every report of injury in the future I am going to try and have that cut out. The railroad companies have experts who are expected to make these reports, and the duty of the railroad surgeon is to report the facts as he finds them and allow the injured party's story to go to the claim department.

Dr. W. B. Outten of St. Louis: Speaking of cases of traumatic neurosis and of expert testimony given in such cases, it is a sad thing to say, but it is nevertheless true, that you can go to any large city in the land, you can group your medical experts side by side, the very best men in the country, and you can create directly an opposite feeling of opinion in any case. You can create a combative disposition between your experts, and your expert testimony when given under those conditions is not worth one iota. I have no objection to any railroad surgeon making a statement, but I have an objection to any man who will even suggest how he should make it. Let him tell the truth. If he says he don't want to make a statement in regard to this or that particular case, that ends it. Whatever he says has got to stand, whether it is the truth or falsehood. It is improper for any doctor to lend his influence to a railroad company by stating that which is not true. He should not deviate a particle from the truth, or from a plain statement of the facts as he sees them. His function is entirely in the line of truth, and, as I have said repeatedly, in my dealings with railroad surgeons, they have aided me the best they could in giving facts and telling the truth in regard to cases. Gentlemen, we have nothing to do with courts of law. we have nothing to do with the claim departments of the railroads we represent beyond telling them the truth.

Dr. Ben Thompson of Tama, Ia.: At the last meeting

of this association, held in Milwaukee, I had occasion to refer to a case of transverse myelitis in the paper I read. This man's name was Anderson. In alighting from a car he stepped upon a piece of coal or stone lying alongside of the track, and in order to save himself from falling he turned short around and jumped to one side. Immediately he was seized with pain in the back, and the surgeon of the company, being on the train, told him that he had lumbago of rheumatic origin. But this man went home, which was on a Sunday, and went to bed completely paralyzed. On Monday there was inability to retain feces, also inability to pass water. His temperature arose to 1021⁄2 degrees, and there was general gradual emaciation of the lower extremities. He was in bed for weeks, and about six months afterwards went to Chicago and was examined by a surgeon of the company, who discovered that he had a myelitis, but not of traumatic origin. A short time after that a Chicago surgeon (Dr. Bevan) discovered that he was totally disabled from being a railroad employe. He got his compensation from the company, and still he was not well. About three months ago (I don't know whether he had heard of the suggestion treatment of St. Louis or not) he came to St. Louis, and remained here for three months. He returned home not any better.

I think that frequently, from an apparently slight injury, patients do sustain an injury of the spinal cord, which is irreparable, and the neurosis in this case was with the physician, not with the patient. This man settled with the company six months ago. He is not improving, and I am of the opinion that he never will improve.

I think we should be very careful in making a prognosis in these cases. The prognosis given to this man, when he was in Chicago for the first time, was that he would probably get better. But he went back to Dr. Bevan and was examined for an insurance company, who told him that he never would get well; that his spinal cord was irreparably injured. Now, all of the suggestive treatment in the world would not effect a cure in this man's case if he lived until he was as old as Methuselah. He would still have spinal trouble, and all the suggestive treatment one might give him would not even bring about an improvement, because he has a traumatic injury of the spinal cord. These are the cases that come to the railroad surgeon at times, and it should be his duty to be exceedingly careful in making a prognosis.

Dr. H. C. Fairbrother of East St. Louis, Ill.: I rise, just for a moment, to take exception to the position of my friend, Dr. Outten, namely, that the railroad surgeon should keep clear of the claim department. I do not think such a statement as that ought to pass unnoticed in a meeting of railroad surgeons. I think the element of legal railroad surgery, if I may call it that, is the most valuable part of the work of the railroad surgeon. I do not think that the railroad surgeon should do merely surgical work and stop there. I merely want to enter my protest against the position that the railroad surgeon should not dabble in anything outside of railroad surgery.

Dr. Gardner of the Indian Territory: I have been practicing among miners for the last ten years. I have seen some of them buried under tons of coal and slate, so that it took six men to lift this material off them. I have seen them buried, doubled over, twisted sideways, work

ing like a miner does, on his side, and when the coal falls it twists him all sorts of ways. I want to say in this presence, in ten years' mining practice I have never met with a case of spinal neurasthenia, spinal injury, or any of those cases we have so much trouble about in railway work, without demonstrable fracture of the spine.

Dr. Booth (closing the discussion): I shall occupy very little of the time of the society, because there has been very little, if anything, developed antagonistic to the paper. I expressed the thought in my paper that these neuroses were largely the suggestions of the doctor, and carried on by the lawyer. But there is one thing, of course, that has been brought out by a great many, namely, First Aid, and First Aid to the nervous is as important, in my opinion, as is First Aid to the wounded, and a surgeon should be careful what he says to a patient at the first examination, and not lead him to expect such troubles following his accident. It seems to me the solution of the difficulty is for the doctors to get together, examine the patient conjointly, both sides, just as they would an ordinary consultation case, and see how close they come together and how far they are apart. Then, if there is disagreement, let the case go to the court in that form or to the claim agent, as the case may be, and they can decide accordingly. I agree with most of the speakers that our duty is plain, namely, to testify to simple matters of fact, and this is what the railroad companies want.

THE NEURAL AND PSYCHO-NEURAL ASPECTS OF SURGICAL PRACTICE.*

BY CHARLES H. HUGHES, M. D., OF ST. LOUIS, MO., Former Surgeon-in-Chief of Hickory Street, M'Dowell's Prison and other Hospitals; Professor of Neurology and Psychiatry, Barnes Medical College; Editor Alienist and Neurologist.

I speak to you to-night by warrant of both surgical and neurological experience-an early life surgeon, later evolved by an unusual line of clinical experience into a neurologist. But like the memory and influence of an old love, my heart turns back to its first fancies and seeks to secure good to the object of its early affection. The first decade of my professional life was surgical; the latter has been medico-neurological.

Surgeons have long known the significance of knee pain in hip-joint disease through neural knee-joint connection. The importance of the nervous system in its relation to surgical diagnosis had a forceful exemplifica

tion in the ease of the lamented President Garfield when that persistent pain in his toe and foot, which the distinguished patient complained of, was spoken of daily by

him, without due notice being taken thereof by his surgeons, as referring (which it did) to its source of anatomic irritation in the lower lumbo-sacral spine, where a vertebral injury was discovered post-mortem, as having been in the track of the assassin's fatal bullet. (Tar

sal branches, anterior tibial; branch of the external popliteal; branch of sciatic, origin of sciatic. (great) lumbo-sacral spine, sacral plexus, 1st, 2d, 3d and 4th lumbar; Ist, 2d and 3d sacral.) That great operation on the nervous system, trigeminal gangliectomy, *Read at fifteenth annual meeting I. A. R. S, St. Louis, Mo., April 30May 2, 1902.

Note. This paper is part of a chapter in the author's forthcoming book on "Neurology and Neuriatry, Psychology and Psychiatry in Practice.

for which Spiller and Frazier now propose division of the sensory root within the cranium for tic doloureux, as a substitute for all other operations on the Gasserian ganglion, reminds us also how closely in touch are neurology and surgery, and the later improved results, according to Krause and Carson's records for Gasserian ganglion excision, show the conjoined benefits of improved surgical technic and advanced neurotheraphy. The screening of the eye alone doing much more to save the central nervous system than the external cye alone. I first invite your attention to

TUFFIER'S LUMBAR PUNCTURE IN SURGICAL DIAGNOSIS AND PROGNOSIS.

Tuffier's remarkable lumbar punctures, which I have had the opportunity of witnessing in Paris, have developed much more than therapeutic significance. Tuffier himself gives the operation diagnostic significance in an article in the Bulletin and Memoirs of the Society of Surgery last year (No. 27), suggesting that subarachnoid effusion of blood mingling with the drawn cerebro-spinal lymph meant internal spinal fracture. Here is a diagnostic procedure of importance in obscure fracture of the vertebræ, with possible greater internal than external damage to the integrity of the spinal canal and the important nervous structures and vital centers of sensation, motion and visceral function which this neural bony conduit encases and protects.

Suppose lumbar puncture had been in vogue in surgery at the time of President Garfield's fatal wounding and employed in that remarkable case, i. e., provided that President Garfield had had for his medical counsel a really advanced expert surgeon, at the beginning of his wounding, in full rapport with the present wonderful resources of neurology and surgery in diagnosis? As it was, President Garfield had, at the commencement of that fatal case, the counsel of a medical politician, more noted for his political pull than his surgical skill, and famed chiefly as the advocate and promoter of the now exploded Condurango cancer cure, that was then working marvels like the oil wells and some of the goid mines of the present day and other fakes in the newspapers.

Lumbar puncture for diagnostic purposes is a procedure. for the later stages of suspected spinal injury, either of the meninges, the cord proper, or the bony canal, after giving the effused blood, which is likely to be small in

quantity in the beginning, time to accumulate and stain the cerebro-spinal fluid. In estimating the value of this new lumbar puncture sign the same principles would

apply to it as elsewhere, viz., the extent and degree of hemorrhagic discoloration. This sign might also prove useful as one element in the prognosis of the possible after effects to the cord; those sequences of concussion and molecular injury to the cord, which cause so much gation, distress to victims of spinal injury concussion and trouble to corporations and so much real, as well as liticerebro-psychic shock and cause the clashing of victim and company, of neurologist and surgeon in the courts.

LUMBAR PUNCTURE AND NEURO-OR CYTO—DIAGNOSIS

GENERALLY,

The lumbar puncture needle promises to be of as much. service to the near and new oncoming neurology and surgery as the ophthalmoscope, microscope or the re

agents of chemistry have been and now are. Neurosurgical diagnosis and prognosis are even now receiving new impetus from them in many directions. Recently, before the Medical Society of the Paris Hospitals, many wonderful and valuable reports have been made of this method of cyto-diagnosis, beginning in October, 1900, with the reports of Widal and Sicard and Ravaut, his assistants, to whose work the Philadelphia Medical Journal refers editorially with well-deserved commendation. Since the first communication of Widal a flood of reports confirming the value of this method of cyto-diagnosis have appeared in the literature of clinical neurology and general medicine. Monod, as this wide-awake periodical notes, last year, in Paris, examined the cerebro-spinal fluid of fifty nervous patients, finding leucocytosis in locomotor ataxia and general paralysis, finding nothing significant in alcoholism, hysteria, hemiplegia or neuritis. Chauffard, Boinet, Rabaud (same source as above, viz., Bulletins and Memoirs of the Medical Society of the Paris Hospitals for last year) confirmed the findings of Widal and his assistants in tabes and general paralysis.

Many interesting showings were made by examinations of the fluid too lengthy for detail here, among them Nageottes' finding that in syphilitic meningo-myelitis mononuclear leucocytes predominating in the cerebrospinal fluid, while in the non-specific cases the majority of the cellular elements are polynuclear. The cerebro-spinal fluid was found normal in hemiplegia, brain tumor, etc. In tubercular meningitis, lumbar puncture showed increasing lymphocytes and low osmic tension, while this cerebro-spinal fluid injected into rabbits caused tuberculosis.

Here is an important feature in which surgery may assure itself as to the state of the meninges after surgical operations and of the existence or nonexistence of tuberculosis, perhaps of the central nervous system, when spinal puncture is used for anesthesia.

The cerebro-spinal fluid after this operation should invariably be saved and microcytologically examined. The number of leucocytes should be examined and counted. Laubry (same source) reported a case of supposed tubercular meningitis disproved by this form of cytodiagnosis, where autopsy showed cerebellar tumor. This work is still going actively on in France. American surgery should take it up, and keep it up, until the new mine of diagnostic wealth shall have been worked out. In miner's parlance there is undoubtedly "rich pay dirt here," for clinical surgery as well as for neurology.

IDIOTROPHIC AFFINITIES AND REACTIONS OF NEURONES.

The central neurones have their special nutritional or idiotrophic affinities appropriating what they need from the blood current for their nutrition, which means their growth, life and function and selecting their own peculiar manner of response to psychic, peripheral and toxic impression as we see in the phenomea of the reflexes of the brain and cord, the pupil reflex and the knee reflex for instance, the psycho-motor movements of a convulsion, the opisthotonos of spinal meningitis and tetanus, the tremors of sclerosis and paralysis agitans, the altered brain. workings of convulsive tic, of trigeminal neuralgia, etc.

The physiology of the five or more senses is based on this peculiar reaction of central neurones to peripheral or central impression. They select their own special im

pressions of smell, taste, touch, sound, sight, weight, etc. The knee kicks up, the foot jerks down, the chest expands, the gullet contracts downward, the bronchi and diaphragm contract so as to throw air and mucus upward, as in coughing, when their special centers are set into reflex action by peripheral excitation, so we also have the phenomena of fecal and urinary expulsion, peristalsis, etc., etc.

The irido or iris reflex is a true idio reflex. There is no other like it. It contracts to light and to certain drugs like eserin, and expands to darkness, atropin, cocain and other mydriatics. Idiotrophic means, strictly speaking, from its derivation (when applied to a neurone or group of neurones making a nerve center), a peculiarity of nutrition or selection of its nutrition. But we extend its signification. The selective affinities of certain centers of the brain or cord for anesthetic, motor or sensory impression or what has been called the selective affinities of drugs which are idiotrophies of the neurones, is a subject to thoroughly consider, and their psychic impressibility in surgical practice.

Barker, whose book is the bible of modern American neurology, as Nissl, Van Gehuchten, Lenhossek, Cajal, and others are abroad, and, in fact, of the mundane neurology of our day, for in it are the sayings of the wisest and best sages and apostles of our faith, concerning the doctrine of the neurones, following a well merited defense of Johannes Müller, who gave to neurologic science the "doctrine of the specific energies of nerves," says "it has been left for the neurone doctrine to explain, if it can, why it is that on stimulation of the retina or of the optic nerve, for example, the response always occurs in one and the same manner; no matter whether the stimulation be by normal methods or by mechanical or electrical means, the sensation of light or of color alone is yielded; or how it happens that when a cold point on the skin is stimulated, whether it be with ice, the prick of a sharp tooth pick, an electric current, or a piece of hot wire (cold point paradoxical reaction of von Frey), the sensation of cold always results. The constancy of the quality of the reaction, despite the variability in the form of the external stimulus, is one of the most puzzling of the phenomena with which the neurologist has to deal."

To me this does not seem so puzzling in view of the idiotrophic properties of the neurone as I here use the term. Though Barker still considers the question as obscure and refers to well-known pathologic cases in which direct irritation of certain areas of the cortex "has called forth definite sense perceptions, as evidence that these sense perceptions speak for direct relation of these bodies to the specific energies of the sensory nerves." The explanation is in that wonderful individuality of the neurone, to which I have already referred as the crowning cap sheaf, cytological discovery of the nineteenth century making the name of Ramon y Cajal immortal. The idiotrophic property of the neurone unit explains why "odors, images of colored objects, memories of muscular movements, and of sounds have been experienced by individuals suffering from the pressure of cysts and other bodies upon the corresponding cortical sense areas," and why normal sensations reappear in nerve centers when limbs are removed, and why memories of impression, psychic or physical, persist. We need not subject the matter to the

test of reason. It appears as an axiomatic truth of the new cytology, that the neurone has this property, as the character and proof of its individuality as distinctive and individual as the selection of its own reconstruction, nutrition. As distinctive as its chromophile and achromatic properties.

THE NUTRITION AND CONSERVATION OF THE NEURONES, OR NEURO-AND PSYCHO-NEUROTHERAPY

IN SURGERY.

The popular misconception of the surgeon is that he is only a cutter. This misconception extends often to the surgeon himself, and it is not always confined to junior surgeons, who might be excused for knowing no better. In consequence, there sometimes develops in the surgical mind a flippant skeptical treatment of the resources of medicine, especially of the wonderful modern neurotheraphy.

The popular misconception of the neurologist is that he is fitted to treat only nervousness and the neuroses of hypochrondria, neurasthenia and the imagination, and to fool with a lot of chronic maladies of the cerebrospinal axis and peripheral nervous system, requiring more time and patience than the average surgeon has to devote to them. But I tell you as a medical man of once extensive surgical practice, that neurology and neuriatry are fundamental in medicine and surgical practice, and they cannot be longer ignored in either clinical medicine nor in the most possibly successful clinical surgery. It is the surgeon who treats the whole patient, neuriatrically and psychiatrically and otherwise therapeutically, up to the advancing modern standards, who will carry the greater trophies of recovery in his warrior belt as the conqueror of disease.

There is a psychic and neural and psycho-neural antisepsis, as well as, and no less valuable, as affecting prognosis, than the antisepsis of the vascular and absorbent systems, which have made Lister and many of his followers immortal and enabled modern surgery to invade and rescue victims of disease from the very grasp of death. Added to Listerism and the dauntless skill of its world applauded votaries in your illustrious ranks, comes now modern neuro-therapy that enables disease's prostrate and imprisoned victims to hold out through judicious cytological reinforcement, till the new and conquering surgery accomplishes its saving work and rebuilds and restores the assaulted central neurones.

THE PSYCHIATRIC FACTOR IN SURGERY

Consists in conserving the integrity of the psycho neurones by withholding from the patient and avoiding both during and after the surgical operation, everything that may tend to lower mental or physical vitality. To this end blunt announcement of an operation intended and abrupt statement of possible doubtful prognosis, the needless display of the surgical tray and the prelude preparations and discussion of the intended procedure by nurses, except under the specific, detailed directions of the surgeon, should be avoided.*

The employment of anesthesia in our day has saved The little surgeon who pompously displays his tray of instruments before his trembling patient and to his woeful wondering mind descants upon the operation he is about to perform, and the chances of recovery, or displays a nonchalant unfeeling mien, acts unwisely and does not increase his patient's chances of getting well quickly.

And the great surgeon who takes his patient into the operating room and places him while conscious on the table, himself, with instru

As a sound neuro-surgical aphorism I should say, from the standpoint of a broad experience, avoid all sources of psychic depression and consider well the nervous system of your patient before and after every operation. There are some constitutions so neuropathic and psychopathically predisposed that the shock of such an announcement would precipitate a crisis of mental alienation and it were better that the proposed operation should be abandoned than insisted upon under such circumstances, or that the patient should be gradually approached and prepared by cautious speech and suitable precursory reconstructive and tranquilizing neurological treatment. Many of the post-operative insanities and neuroses result from awakening into active life the psycho-neuropathic diatheses and might not result in neurotically well prepared or psycho-neurotically well endowed nervous organisms.

And these, Gentlemen, are the victories of modern surgery: A skilled technic never before equaled. Anesthesia, general, peripheral and spinal; antisepsis, cytotherapy. And the honors are even, for anesthesia and cytotherapy are ours. Antisepsis and the new operative technic are yours. Fortunately for mankind these advances are all in the one family and that family is one for the weal of a suffering world.

POST-OPERATIVE INSANITY.

As a suitable addentum to this paper, let me here quote one of my editorial criticisms from the Alienist and Neurologist of October, 1901: A St. Louis surgeon having performed an enterorrhaphy with acute mania without sepsis as a sequel gives this as the rule adopted by most surgeons, viz: Under no circumstances ought any insane woman to be operated upon unless for some distinct condition that is compromising life.

This is not a rule based on a clinical knowledge with those who have done their own surgery in a hospital for the insane or have advised surgical procedures on the insane. A grave surgical disease preceding insanity or supervening a psychosis may be removed unless the proposal to operate and the preparation and operative procedure are in the line of and tend to aggravate the patient's delusions. Rules of therapeutic procedure medical, moral or surgical in psychiatry are out of the range of the average surgeon's clinical experience and he should defer to psychiatic judgment in the premises and not for mulate rules purely from the surgeon's standpoint. The practical alienist might enlighten surgery in some surgical quarters where surgeons walk in darkness and the darkness comprehendeth not.

ments in hand, while white aproned attendants gather around the victim, approaching with sponge and bottle and instruments and appliances of the impending operative procedure, is not so wise a surgeon, and does not so fully consider the effect of depressing psychical influences as he who chloroforms the intended subject of an operation in another room or in the same room without these depressingly suggestive influences.-Alienist and Neurologist, Oct., 1896.

I would like to ask if this is the rule adopted by most surgeons? If so it is not a wise one. Sources of physical drain and imitation should be removed, if practicable, from the insane and nervous as well as the sane and nervously well.

DISCUSSION.

Dr. C. B. Stemen of Fort Wayne, Ind.: I did not expect to be called upon to discuss this very able and admirable paper, and I must confess that I am not able to do so. I want to thank the author, however, for bringing before us the results of original research and scientific investigations, which are of great value to the medical and surgical profession. I have been very much pleased in listening to the paper. I believe we should devote more attention than we do to the neurologic aspect of our cases. The surgeons before me to-night know very well that an individnal, seriously injured, may be doing very well; yet some individual entering the sickroom and inquiring how the accident happened, and having the patient go through with the details of the accident, so far as he recollects them, very frequently the patient is so susceptible that he may have a chill, with high fever, as the result of that interview, which may prove serious. There is much yet to be learned; there is a great deal which neurologists must bring out for us, in order to aid us to resort to the proper surgical procedures.

THE EXAMINATION OF THE EYES OF RAILWAY EMPLOYES.

BY FRANK L. HENDERSON, M. D., OF ST. LOUIS, MO., Professor of Ophthalmolozy in the Barnes Medical College. Consulting Oculist of the Wabash Railway and the Terminal Railway Association, Etc.

All articles on this subject deal with the precautions necessary to the protection of the public against injury and the railroads against loss. No thought of protecting the employe or applicant for railroad service ever enters into the methods suggested by writers or adopted by our leading roads. Yet it is possible for a competent examiner to discover, with the greatest ease, a condition in the applicant which does not debar him from entering the service, but which, in the course of time, will, almost certainly, render him unfit for his duties and result in his discharge if his disability be discovered. I refer, of course, to hyperopia. The examination, as conducted by most roads, requires that the applicant shall be able to read a given sized letter at a certain distance, with each eye tested separately and without glasses. This is readily done by a man under 45 years of age, even though he may have hyperopia of high degree. I have in mind a man who has six dioptres of uncomplicated hyperopia in each eye and has a vision in each, without glasses, of 6-6 plus (normal). He could pass the examination of any road in the United States, as now conducted. Let us presume that he does so. He is given a report of normal visual acuity and enters upon his work under the impression that his eyes are of the best. I will not dwell upon the numerous inflammatory conditions which the constant, excessive strain of the ciliary muscle, necessitated by his hyperopia, may produce and which

may end his railroad career at any time. He may pass through years of eye strain and eye pain and yet be able to pass the examination required by his employer at any time under the age of 45. But trouble is in store for him with absolute certainty when he reaches this age, for the period of presbyopia now sets in, the lens begins to lose its elasticity and can no longer compensate by increasing its convexity, his hyperopia becomes more and more manifest, his vision changes from normal to bad, and from bad to worse. If, at this time, he is given a special examination, or if an examination of all employes is instituted, it will be found that the trusted engineer of fifteen years' experience has such poor vision that it is necessary to drop him from the service or make an exception of his case, a course which will not be conducive to the good order and military discipline for which all of our best roads are striving. An applicant with 6 dioptres of hyperopia might pass the entrance examination, but his error need not be so large, for four or even two dioptres of hyperopia will encompass his downfall in time, if the regulations are strictly interpreted. The most unfortunate feature of this condition of things is that the dismissed employe has devoted the best years of his life to an occupation which he is forced to abandon when too old to take up a new line of work. It is also true that once a railroad man, always a railroad man, since there seems to be a certain fascination about the work which unfits him for any other vocation. Furthermore, his dismissal will come at a time when he is most liable to have a dependent family on his hands, or, owing to the fact that railroad men begin to save late in life, if they save at all, he may be in the midst of payments on a home or a life insurance policy which he is forced to abandon at great loss.

Not long ago one of our leading roads issued an order for the examination of all its employes "in the transportation, motive and telegraph departments," from which order the following is quoted: "Each eye will be tested separately. If the examined, with the unaided eye, cannot see number 20 of Snellen's type at a distance of twenty feet, he should not be approved." This rule was amended by a footnote, which said: "When the vision of one eye is 20-20, or normal, a defect greater than 20-40 in the other eye should not be approved." I was appointed a court of last resort to pass upon all doubtful If the local surgeon who conducted the examination or the employe examined desired a more thorough test, he could appeal to me. In this capacity I was compelled, under the instructions above quoted, to approve the dismissal of a number of old employes whose only crime was that they had served their road long enough for their hyperopia to change from the facultative to the absoulte variety. In some instances the hardship to the employe, who was in other respects in his prime, was severe indeed.

cases.

The remedy for this evil will necessitate the examination of applicants by one competent to determine the existence of hyperopia of such degree as will eventually disqualify its possessor. The local examiner can learn to do this very readily, using a cycloplegic in doubtful cases. Of course, this work and all eve work of whatsoever kind should be done by an oculist when possible.