VOL. IX. INTERNATIONAL ASSOCIATION OF RAILWAY necessarily gathered a class of cases of terrible and com SURGEONS. MINUTES OF PROCEEDINGS OF THE FIFTEENTH ANNUAL MEETING, HELD IN ST. LOUIS, MO. APRIL 30 FIRST DAY, MORNING SESSION. The association met in the Pickwick Theater and was called to order at 10:53 a. m. by Dr. F. J. Lutz of St. Louis, in the absence of Dr. Outten, chairman of the committee of arrangements. In the absence of his excellency, Governor A. M. Dockery, Dr. Lutz delivered a brief address of welcome, after which he introduced the president of the association, Dr. Rhett Goode of Mobile, Ala. President Goode then delivered his annual address. The keystone of the philosophy of the past half century is that of progress, change, development and improvement. Succinctly put, it is the law of progress, from the homogeneous to the heterogeneous. It is, in social life, change from the general to the special; division of labor, specialization of industry; deviation from the normal and general, branching of various arts and sciences till each branch almost becomes a specialized individual. This great law of evolution applies to us as a social body as well as to every other social body. Generally we are physicians and surgeons; specially, as classed by this organization, we are railway surgeons. Wherever there is a special development in society, wherever an industry, art or science develops to such a degree that special parts of it are devoted to special lines of work, there is and must be some basis for the specialization; hence, with us, there must be distinctive functions which we, as railway surgeons, subserve. It may be that this classification is possible merely because we are associated in our profession with the railroads, but a little closer inspection will show that we are so associated for the reason that there is a special division of surgery in which we are to specialize our labors. This special division exists because of the peculiar and disastrous results to human beings consequent upon the conduct of railroad traffic, because there are injuries of special characters resulting from men being crushed by enormous weights moving with great velocity, from men being struck by such masses, or from human beings moving at great speed being hurled violently against such masses, crushed in wrecks, bruised, maimed and mangled by terrific forces. The result of such collisions or of such crushings is so different from general operative surgery that there is plex injuries which are just as readily classified as those called gunshot wounds. Of course, in railroad surgery there arise many cases of minor surgery which do not bear the special characteristics of railway injuries; but the same occurs in military surgery, where, though at times special knowledge, judgment and science of the highest character are demanded, the general cases treated by the military surgeon of a minor character. The special injuries treated by the military surgeon are those received by the human body being struck by small masses moving at great velocity. The injuries thus received are the opposite of railroad injuries. Such injuries as the railroad surgeon is frequently called upon to treat were seldom treated previous to the establishing of railway lines. It is not to be wondered at that railway surgery is really a greater and far more important branch, if possible, than military surgery. The railway surgeon is always in demand; the military surgeon but seldom exercises to any degree his special attainments. Thus, though there is a classifiable difference between military and railway surgeons, yet they are but the two divisions of the greater division of traumatic surgeons. Their special qualifications lie in the treatment of wounds, and thus as traumatic surgeons there is a tie that binds the two together. So closely are they allied that it has occurred to me, as an observation of our war with Spain, that it would be of the greatest value to our government to have upon its lists, as eligible for appointment and desirable because of experience, a body of surgeons skilled in the treatment of injuries, ready for service in the volunteer army in case of need. The need of experienced surgeons in time of war is extreme, and nothing could be tendered the government which should be more acceptable than the services of such a corps, ready for immediate service. In regard to fitness for such work, none are better qualified than the railway surgeon, who are a class of men selected by the various companies because of their special ability in dealing with injuries. I would suggest that this matter be considered by this association and such action taken in regard to it as may be deemed wise. It is the function of this organization that it has to do with railway surgery and should have as its aim the instruction in common of its members in special features of railway surgery, and in proportion as it centers its endeavors upon special cases arising from railroad accidents and of injuries peculiarly classifiable as railway injuries and hygienic and sanitary matters peculiarly asso Railway surgery is a comparatively new specialty. Its growth has been principally during the past twenty years, and its recognized specialized growth may be placed within the past ten years. In a general way the peculiar features of railway injuries have been treated, but I may state that the time is now ripe for the general and close classification of the special features. It is difficult, in any department of our profession, to advance any absolutely new idea. Development lies principally in the close, sound, healthy development of the old, not the adventitious growth. The valuable discoveries in medicine and surgery of to-day are enormous, but I may venture that the most worthy of commendation are those which consist of improvements in old methods, making more nearly certain the results to be attained. ciated with railroads, just in that proportion it perfects balance sheet. The services of attorneys and surgeons the demands which caused its existence. are not so measurable, being in great part problematical and invariably in the expense column. Almost every railroad injury we treat comes either to the knowledge of the claim department or the legal department, and tends even toward the courts. If the case escapes adjustment it goes to the legal department, which must call in the surgeon to assist in the estimate of damages. Thus, in the first place, the physician does all possible to reduce the grounds for claims for damages to the lowest possible amount by reducing the effect of the injury, and in the second lends his assistance to the legal department in getting at least a just assessment of monetary damages. In reality all matters subsequent to the accident are relative to only two departments, the surgical and legal, though of necessity indirectly under the general management, and any report to any other department is a matter of useless and delaying routine. Therefore it were better for the surgical department to be auxiliary to the legal department, to which all reports of injury should be made and the progress of the injured. The records are thus primarily lodged with the proper department for reference if need be, and which has charge of the settlement of damages either in or out of court. Such a system is now, and has been for the past eight years, in practice on the Mobile & Ohio Railroad, and that to the great benefit of all concerned. This suggestion is made to this association at this time for the reason that I believe it is a system more nearly adjusted to the needs. of railroads, and as one which would probably bring the surgeons in closer touch with the department which can better value their services. I would say that this is said without criticism, for generally surgeons get fair compensation for their services; however, oftentimes without nearly the full measure of appreciation of the value of their work. Science consists of classified knowledge, and if our special department of railway surgery admits of classification of its facts, then it is time that classification were made so that railroad surgery may stand more nearly completely specialized. I trust this suggestion may bear fruit and that some worthy and highly competent member of this association may distinguish this society by such momentous work. As for our relations with the railroad companies, I may say that I do not think our employers appreciate to the full degree that special qualifications are necessary to the railroad surgeon. Nor must it be expected of them. No man can appreciate an art or science till he is a master of it. And again, our true relationship to the railroad is overlooked. This is because railroads are business corporations, the managers of which are financial men who have been taught to give more of their attention to freight and passenger interests than to what may be considered minor affairs. They are trained to the idea, and justly so, that the all important questions before them are to secure freight and passenger traffic and avoid unnecessary expenses in handling the same. They demand that all classes of labor shall show positive results on the books and be measurable in coin. But the pirate maxim, "Dead men tell no tales," is not true in railway management. Maimed live men are also oftentimes extremely expensive affairs, but in the great majority of cases they are expensive in direct proportion to the lack of science and skill shown in treating their injuries. But this as applied to any and special cases is known in reality only to the surgeon or to such superiors. of his who may be familiar with the facts. It is to our interest that these facts be brought in the best manner possible to the attention of our superiors. I would in this in no way make criticism of the managers of our roads. They are gentlemen of the highest character and intelligence; they are men who are laden with enormous responsibilities, and it cannot be expected of them that they shall diffuse their energies by giving attention to details. I would suggest, however, that there is an order of management which might be considered. It may be best to explain it indirectly. In a general way there are two departments of railway management which are closely allied-the legal and the surgical. They are assistants in the conservation of revenue; all others produce results which show on the Again, as regards our duties to the railway companies which we represent, I may call your attention to the practice upon the Union Pacific and other railways of instructing employes in the First Aid to the injured. It need hardly be mentioned that a majority of the cases of injuries coming to our attention are those sustained by railroad employes. Their duties are hazardous at the best. Generally railway employes are men who have had little or no practical experience or instruction in attending the injured immediately after injury is sustained and during the time that generally elapses between the time of the accident and the arrival of the surgeon. Yet we all know that only too often does the result of an injury depend upon the attention during that time. It was due to this and that very practical idea adopted by our government of providing its soldiers with the "First Aid Package" that the Union Pacific first adopted the package for general distribution, and later, finding that there was a gross lack of knowledge as to how to use the contents of the package, established a system of instruction of employes. The results, as reported by Dr. A. F. Jonas, chief surgeon of that system, are highly gratifying. The employes are given general instruction in anatomy and physiology, at least enough to make the latter instruction intelligible. This instruction is given in a lecture upon which the employes are examined. Later they are given instructions in regard to the use of |