collectively), as a rule, in ninety-nine cases out of a hundred it is an injury to the muscular tissue. You either have a tearing of the muscular tissue, or a sprain of the muscle. You have with it an exudate or extravsation of blood confined within the fascia that surrounds the muscle, or you have a tearing loose of the muscular tissue from its attachment, or bruising of several muscles surrounding the parts. Under these conditions, when you have an injury or a sprain, what happens? A sprain never occurs unless the muscles are taken unawares : they must be taken off of their guard. Under these conditions you will have a sprain of either one of these joints. Without those conditions a sprain will never

occur.

When a sprain occurs the capillaries are broken, the arterioles are broken, and you have either extravasation into the body or muscles, or it may be intermuscular in character, filling up the fascia.

A common occurrence around the shoulder is a rupture of the arterioles or capillaries around the joint and effusion outside of the capsule, without much extravasation of blood and accumulation in the muscular tissue lying about and around the joint. Just in the deltoid muscle is a triangular space which is filled with muscular tissue. This is the favorite seat for extravasation of blood in the shoulder, with accumulation and deposit of fibrin, which, unless removed, interferes with the joint by its impingement on the circumflex nerve. You have a joint that is painful, useless, with disinclination and inability to use the deltoid muscle; as a consequence the man's arm hangs by his side. On the treatment of the case within twenty-four, thirty-six, or seventy-two hours, the future usefulness of the man's limb will depend. Unless the circulation is reestablished and nerve excitation of the parts is reestablished, you must have extravasation, with accumulation and organization of that clot, and you have a permanent injury which may last six months or years, owing to the character of the treatment adopted. The first twenty-four or seventytwo hours will determine the future usefulness of this joint, and that treatment is to press the blood out of the Farts by good, firm strapping or bandaging, forcing the deltoid and the other surrounding muscles down into the tissue, and within twenty-four or thirty-six hours all around the deltoid muscle you have an exudate showing red and green from broken down extravasated blood. Press it over the head of the bone; if you don't do that, and allow the blood to remain there, and it accumulates in these parts, the patient will have a long and tedious recovery. By properly forcing it out into the fascial space, and not allowing it to accumulate in one place, you will have done the right thing.

Look at the joint. What occurs in a joint that is not used? What excites the flow of the synovia? Let us see. Let your joint remain at rest for two weeks and you have a dry joint. When you have that, you have a shrinking of the capsule. You have a capsule that shrinks and you have a breaking of the joint; you have an inflammatory action and breaking down of cells on the surface of the synovial membrane, with roughening of the joint; if you move it, it will rub and creak, and cause a great deal of pain and annoyance. What is the condition that follows when you move the joint? You

bring about renewed inflammatory action; it brings about renewed extravasation because there is more or less breaking down of the little granules in the joint. There is more or less extravasation of blood into the joint at that time. Then you have another danger which you

must overcome.

I shall confine my remarks largely to injuries of the shoulder, because time will be too short to discuss the whole question. A practical and physiologic basis of treatment of shoulder injuries is the only course to pursue. You have extravasation of blood, you have accumulation of blood, and binding together of the tissues. Look at the muscular tissue; each strand of muscle is surrounded by a delicate membrane. This exudes material similar to synovial fluid. You recognize the fact that no muscle contracts or expands under it. Each strand contracts or expands with the individual cell. When you have extravasation into muscular tissue, what occurs? The same condition obtains which you have in the other joints. There is an accumulation, a binding together of the muscles. When you see that, you will find you have a large bunch of muscle, a great mass, which will not move with any degree of regularity. As a consequence, the ability to use that joint, to bring it into active use with the other joints, is less, because the mechanism that moves it is impaired.

Let us proceed further. You find in all these conditions intense tenderness of the integument, which is due not to any injury of the integument, but to a neuritis which is set up by a deeper injury, and the reflex effect on the skin. If you touch the part with the point of the finger, if you apply firm pressure, the patient will say it affords him relief. He does not suffer while that is being done. Put hot applications, if you please, upon the part, because you never see such a joint in time to apply cold applications. (If you see such a joint before extravasation has taken place, cold is indicated.) After extravasation has taken place, hot applications are indicated to excite superficial circulation, to drain the fluid. or blood out. If accumulation of fluid has taken place, the only cure for that joint is use. In ten years I have not allowed any of my assistants to keep a plaster-ofparis cast on a sprained joint longer than three or four days. If a man has a sprained shoulder, he is directed to come to my office daily, and the assistant gives that shoulder thorough massage, so that every tissue is excited, the circulation accelerated, carrying off the deposits. which you will find from the movement of these muscles. Unless you do this, the limb will be permanently impaired. Nature will not accomplish it without the proper excitation. The joints draws up, the ligaments contract, the muscles are absorbed by constant nonuse, and you have a condition that rapidly approaches atrophy. The nerves become more or less irritated, the trophic influence of the nerve is gone, and building power is reduced. It is owing a great deal to the patient who is injured as to what I do for him or her.

If the patient is a child, with a large amount of circulatory apparatus, a large nerve supply, I would treat him differently than I would an old man whose upbuilding or recuperative powers are all gone. You have got to treat these cases differently if you would secure

good results. In the case of a child the inflammatory action is greater; you can use cold applications here when you could not use them in the case of an adult. Furthermore, cold applications to the shoulder of a child can be used later than in the case of an adult. The avenues of escape for the exudate are greater, and you can get the tonic effect of the cold, and tone the muscles up and force them to carry away a great deal of the broken down tissue. In the adult and in cases of old men, the circulation is not rich enough to carry off the broken down exudate as rapidly as possible, and I deprecate the use of rest and tying these joints up and letting the patients go. I am convinced from my observations and long experience that plaster-of-paris and similar methods of treatment are a failure. I travel over the country a great deal in seeing cases of medico-legal interest, and with all due deference to the profession and the railroad surgeon and general surgeon, I say to you that of all abominable treatment, that is the worst.

They put an old man on the stand in the southern part of our state not many years ago, who had practiced medicine for forty-six years. He had quite a local reputation as a surgeon. The case was one of sprained ankle of eight or ten months' duration. The foot had atrophied, the circulation was badly impaired, the temperature was subnormal. We asked him what he thought was the matter? He said it was a sprain. He said he had heard the testimony. We questioned him about his ability, and he replied, "I will tell you what I know about the subject-the less I have to do with sprains the better. When I get a bad sprain, I let it go."

Dr. Rhett Goode, Mobile, Ala.: With reference to sprains of the shoulder and hip joints and their treatment, I think there is a happy medium. In a sprain of the shoulder or hip, I would consider it proper treatment to give the joint rest for a time, not too long, and during this period of rest plaster-of-paris may be applied, a gauze bandage can be applied, and also strips of adhesive plaster to confine the muscles and limit their motion, and, at the same time, other applications can be made. It has been my practice to use an application of sugar of lead and arnica, in addition to the extract of hamamelis, having this applied to the joint continually, keeping the arm to the side of the body, and having this lotion used continuously for three or four days, and instituting passive motion. I do not think the arm ought to be kept confined for six weeks or two months. The true principle in the treatment of these cases is rest at first, with the proper kind of lotions, and when that time has passed you should remove your restraining apparatus, institute passive motion, and stimulate the muscles by electricity or some stimulating liniment.

Dr. J. H. William Myer, Laporte, Ind.: Ind. I agree with the speaker in everything excepting that I would add to the treatment massage. Ofttimes we cannot use massage in a mechanical way so well, and direct stimulation with the electric current will enable each individual fiber to work smoothly in its sheath of fluid, and the particular benefit we get from electricity is more in the nature of individual contraction and relaxation, instead of the more bulky reaction which we get from the use of massage as we give it, or as the osteopaths would give it

to a patient. The benefit which the osteopath gets in chronic cases is due to the fact that he exercises strong pressure from which he gets a good reaction from the muscles, frequently accomplishing something which might have been earlier in the treatment accomplished by the electric current, which would do the same work earlier and more generally. So the question resolves itself into the fact that the treatment must be thorough, according to the stage of the disease.

In a case in which there is stasis, where there has been extravasation or coagulation of blood, I would use the hot pack, combining local massage with a liniment of camphor or arnica, and following that up with gradual electrical treatments, as they become necessary, in order to keep up the life of the muscles and to keep up nerve action.

Dr. E. J. McKnight, Hartford, Conn: There is one point I would like to refer to. If lotions are of any use, it occurs to me they are of much more use after the application of heat. I see a better action for them after the application of heat.

I think the treatment, as outlined by the first speaker, meets with my approval in the main.

Dr. Milton Jay, Chicago: Injuries of the shoulder and hip joints are the most important, the most difficult to deal with of any of the joints in the human body. I do not believe we can lay down any particular line of treatment for all of these injuries. If there is an injury with extravasation of blood, there must necessarily be a laceration of some vascular structure. If a vascular structure is torn, and there is no exudate, but a hemorrhage into the joint or between the sheath and the muscles, there is a different way of treating such a case from one of inflammation of the joint, not torn so as to have hemorrhage, because in one instance you have a strain. of the muscles. They are sore. You have got an exudate, such as you get from an over-strained ligament, and that exudate is plastic lymph. This lymph, if let alone, and the joint is kept perfectly quiet, will be absorbed by nature. But there are some cases unquestionably where it is not well to wait too long for nature to do this work, and hence we resort to movement of the joint. The elder Gross, when asked when shall we move a joint, said, "When it don't hurt you." I heard Frank Hamilton, the author of the work on dislocations and fractures, say in a lecture, "I want to discourage any one of you students from insisting upon moving a joint for fear of getting ankylosis of it."

You will remember about two years ago I read a paper before this association on this subject. If you split the head of the humerus, or if you split the ulna, and treat the case without any movement, I will agree to move the arm and not have ankylosis. You can split the condyles of the femur, you can split the condyles of the humerus, and you can go into the joint a little every time, but you must recollect there is no denuded surface but what is covered with cartilaginous substance. Unless we have a denuded surface a cartilaginous joint will not unite with broken bone. We must have the two fractured fragments brought together in order to get union. If you put an arm to this position (illustrating); put a splint on, in a few days from now, when you take it off,

A

Here is another thing in injuries of the shoulder-joint particularly. I have two cases now, one sent to me by one of the local surgeons. I did not know whether it was a dislocation or not at first. When the patient came to me I could scarcely touch the arm. Anteriorly there was some ecchymosis. For three weeks the man could not bring the arm back parallel with the body. I brought it forward; I examined it as best I could, and spent a long time in doing it, and I found what I have found three or four times before-the long head of the biceps, as it penetrates the capsular ligament, torn loose. week after putting the arm up in splints and bandaging it, the soreness disappeared, and the man has good movement of the arm. I have seen other cases of that kind. Fifteen years ago I had a case of that kind in a railroad accident, but something happened to the man afterwards from another injury from which he died. Post-mortem examination showed the ligament torn loose. Since then I had an old man who sustained a severe fall. He was a large man; I spent two hours in examining him, and then said, "I don't know what is the matter with you." I put the arm in a sling, and came to the conclusion that there was no rupture of the capsular ligament. There was tenderness in front. He finally recovered with a good arm, but it took him months to do it.

In every injury around a joint, where there is an effusion of blood or hemorrhage, whether it be the hip or shoulder joint, if the stretching is sufficiently extensive

to irritate and inflame the muscular structures, it is not good surgery to move such a joint. I have come to the conclusion that it is wise never to move a joint when it hurts the patient. If it hurts the patient to move the joint, naturally we would injure it in making a careful and prolonged examination when he is not anesthetized. It is better to give an anesthetic in cases which require a prolonged examination, then the surgeon can tell something about what he is doing. He can make movements without hurting the patient, and he does not injure the joint by his manipulations.

Dr. Ford (closing the discussion): There is very little I have to say in closing. I say frankly, the surgeon has got to recognize the conditions about the joint. He has got to have his anatomic and physiologic knowledge with him. He has got to be perfectly frank and open in this matter, and must recognize the difficulty. If he is reasonably sure that the head of the biceps is torn off, he must recognize it, if possible. No man would be doing his duty to a patient or to himself, if he found by continued motion of a joint it produced intense irritation and tumefaction. With his anatomy and physiology in mind, the surgeon must base his pathology on the facts elicited about the shoulder-joint. When he does that, with the ordinary proper line of treatment and the application of lotions such as were indicated in the discussion, he will meet with success.

Never be too anxious to make your flaps meet and look well, in removing a cancer of the breast. Your vanity will often tempt you to leave a flap in which cancer may lie concealed.-Fenwick.

SOCIATION.

MINUTES OF THE FIRST MEETING OF THE ASSOCIATION HELD IN KANSAS CITY, MO., DEC. 3 AND 4, 1903.

FIRST DAY-MORNING SESSION.

The association met at the Midland Hotel. Dr. S. C. Plummer, chief surgeon of the Rock Island System, pointed out the objects of the meeting. Among other things, he said that every man who was on the surgical staff was a member of the association. There were no dues to pay. There were no officers except the secretary, and this office would be filled by the chief surgeon. A chairman would be elected at each meeting.

After these preliminary statements, Dr. Plummer asked that a chairman be nominated to preside at the morning session.

Dr. George P. Hanawalt of Des Moines, Iowa, was nominated and elected chairman for the morning session, and Dr. E. N. Allen of South McAlester, I. T., for the afternoon session.

Dr. Hanawalt then took the chair, and called for the reading of the first paper, which was by Dr. N. A. Drake of Kansas City, entitled, "A Few Broken Legs." This paper was discussed by Dr. Grant.

Dr. L. H. Munn of Topeka, Kan., read a paper entitled, "Where and When to Amputate." The discussion was opened by Dr. J. M. Ristine, and continued. by Drs. Allen, Tullis, Plummer, Grant, Fairchild, Jennings, Hartshorne, Christopher, and the discussion closed by the essayist.

Dr. J. M. Emmert of Atlantic, Iowa, read a paper entitled, "The Psychic Element in Railway Injuries." Discussed by Drs. Williams, Jones, Crosby, Bacon, Littig, Andrews, Brown, Duringer, and the discussion closed by the essayist.

Dr. E. N. Allen of South McAlester, I. T., read a paper entitled, "First Aid."

On motion, the association adjourned until 2 p. m.

FIRST DAY AFTERNOON SESSION.

The association reassembled at 2 p. m., with Dr. Hanawalt in the chair.

Dr. Le Roy Dibble of Kansas City, Mo., showed a case of wound of the conjunctiva and sclera.

Mr. George E. McCaughan, claims attorney, Chicago, Ill., was to have read a paper on "The Relation of the Surgical Department to the Claim Department," but was prevented from attending the meeting owing to illness in his family.

Dr. W. W. Grant of Denver, Colo., exhibited a nose bridge, and railway stretcher and splint.

Dr. A. O. Williams of Ottumwa, Iowa, exhibited a case of dislocation of the clavicle from the acromial articulation, complicated with fracture of the skull. Discussed by Dr. Sutherland.

Dr. M. W. Bacon of Englewood, Ill., read a paper entitled, "The Special Value of the Railway Surgeon to the Company, as Compared with the Outside Surgeon,"

which was discussed by Drs. Fairchild, Leipziger, Plummer, and the discussion closed by Dr. Bacon.

Dr. Wm. C. Bane of Denver, Colo., followed with a paper entitled, "The Easiest, Most Equitable and Just Manner of Disposing of Old Employes in Train and Engine Service, Whose Vision Has Become Impaired." Discussed by Drs. Shore, Hartshorne, Hall, Andrews, Dean, Fairchild, Reynolds, and the discussion closed by the essayist.

Dr. A. R. Mitchell of Lincoln, Neb., read a paper on "Fractures."

Dr. L. W. Littig of Iowa City, Iowa, read a paper on "Spinal Injuries," reporting a case and exhibiting a skiagram.

Dr. F. M. Floyd of St. Louis, Mo., read a paper on "Anesthesia," which was discussed by Drs. Grant, Dibble, Spalding, Condit, Dean, Plummer, Fly, Cottam, Hanawalt, and the discussion closed by the author.

Dr. H. M. Dean of Muscatine, Iowa, read a paper entitled "Carbolic Acid." Discussed by Drs. Leipziger, Fly, and, in closing, by the essayist.

Dr. A. H. Andrews of Chicago read a paper entitled "Technic of Eye and Ear Examinations," which was discussed by Drs. Dibble, Bane, Anderson, Dean, Sutherland, Crouse, Plummer, and by Dr. Andrews in closing. On motion, the association adjourned until Friday morning, at 9:30.

SECOND DAY-MORNING SESSION.

The association met at 9:30 a. m., with Dr. Hanawalt in the chair.

Dr. G. G. Cottam of Rock Rapids, Iowa, read a paper entitled "Traumatic Injuries of the Deep Urethra." Discussed by Dr. Kerr.

Dr. F. Vinsonhaler of Little Rock, Ark., read a paper on "Visual Tests for Malingerers."

Dr. Le Roy Dibble of Kansas City, Mo., read a paper on "Color Blindness Versus Color Ignorance." Discussed by Drs. Andrews, Bane, and closed by Dr. Dibble.

Dr. J. E. Summers, Jr., of Omaha, Neb., read a paper entitled "Report of a Case of Gascous Gangrene, Following Compound Fracture of the Leg." Discussed by Dr. Cottam.

Dr. J. S. Kauffman of Blue Island, Ill., moved that at the annual meeting of the association, the first evening shall be devoted to a banquet, at a cost not to exceed $2 for each member. Seconded and carried.

Dr. J. A. Overstreet of Kingfisher, O. T., moved that the month of December be fixed as the time for holding the meetings of the association, and that Kansas City be the permanent place. Seconded.

Dr. J. M. Emmert moved to amend that the meetings of the association be migratory. Seconded. Carried. The original motion, as amended, was put and carried. It was moved that the place of next meeting be balloted for. Dr. Overstreet moved that this matter be left the chief surgeon. Seconded and carried.

Dr. Wm. H. German of Morgan Park, Ill., moved that Dr. Plummer be elected permanent secretary of the association. Seconded and carried.

There was some discussion as to the time of holding

the meetings in December, and, on motion of Dr. Dean, this matter was left with the chief surgeon.

Dr. S. C. Plummer of Chicago then read a paper entitled "Pathology and Treatment of Fractures of the Patella." Discussed by Drs. Middleton, Bacon, Dean, Kerr, Williams, Cottam, Ristine, Klippel, and the discussion closed by the author.

Dr. J. S. Kauffman of Blue Island, Ill., read a paper entitled, "First Dressing of Wounds. and Treatment of Punctured Wounds." Discussed by Drs. Dunn, Maxwell, Gant, Garth, Plummer, and the discussion closed by the essayist.

Dr. Thomas McDavitt of St. Paul, Minn., read a paper on "Injuries of the Eye," which was discussed by Drs. Dibble, Minney, Gant, Sutherland, Shore, Hedrick, and the discussion closed by Dr. McDavitt.

On motion, the association adjourned until 2 p. m.

SECOND DAY-AFTERNOON SESSION.

The association reassembled at 2 p. m., with Dr. Hanawalt in the chair.

Dr. C. B. Gant of Graham, Tex., read a paper on "Human Infection by the Screw Fly." Discussed by Drs. Graves, Maxwell, Dibble, and the discussion closed by Dr. Gant.

Dr. I. F. Crosby of Stuart, Iowa, read a paper entitled. "High Dive Followed by Laminectomy." Discussed by Dr. Davisson and the essayist.

Dr. C. R. Silverthorne of McFarland, Kan., read a paper entitled, "Aseptic Precautions in First Aid to Railway Injuries," which was discussed by Dr. Maxwell, and, in closing, by the essayist.

Dr. W. H. Condit of Minneapolis, Minn., read a paper on "Conservative Treatment of Crushing Injuries to the Extremities." Discussed by Drs. Littig and Dunn.

Dr. D. R. Fly of Amarillo, Tex., read a paper on "Concussion and Compression of the Brain; Differential Diagnosis and Treatment." Discussed by Drs. Tullis, Clark, Hedrick, Klippel, Duringer, and, in closing, by the essayist.

Dr. Ellsworth Wilson of Alva, O. T., read a paper entitled, "The Railway Man's Stomach." Discussed by Drs. Fly, Maxwell, Littig, Hall, Clark, Dibble, Brownell, and the discussion closed by the essayist.

On motion of Dr. Bacon, a vote of thanks was extended to Dr. Plummer for the efficient manner in which he had gotten so many of the surgeons together and had made the meeting such a success.

Dr. Hanawalt thanked the members for their uniform kindness and courtesy extended to him in presiding over the sessions.

It was moved that the paper of Mr. McCaughan be printed in The Railway Surgeon, and that the secretary be requested to ask him for his paper, to be published in the proceedings along with the others. Seconded and

carried.

On motion of Dr. Brownell, a vote of thanks was extended to the management of the railroad for generous treatment in furnishing transportation to and from the Kansas City meeting.

A vote of thanks was extended to Dr. Drake for making preparations for the meeting, after which the chairman declared the meeting adjourned, sine die.

COLOR BLINDNESS VS. COLOR IGNORANCE.*

BY LEROY DIBBLE, M. D., KANSAS CITY, MO.

Color blindness should be classed under two heads: (1) Congenital, and (2) acquired.

It

Congenital color blindness is comparatively rare. is hard many times to separate the acquired from the congenital, and I think this accounts in part for the difference between the amount of color blindness in the two sexes, it being five per cent in males and less than one-half per cent in females. The only way to settle the question would be to examine a great number of children, male and female, at an age where the males had not contracted the liquor or tobacco habits. Color blindness is transmitted from one generation to another. While a student in Zurich some twenty years ago, Professor Horner showed us nine members of one family where it had been transmitted from grandfather to grandson for eight generations, and there had been no intermarriage. Dullness of color perception is also hereditary, but can, by proper education, be overcome. I have never seen a case of hereditary color blindness overcome by education.

There are varying degrees of ability to distinguish shades of color. We often hear of artists who have great color perception and are known by their ability to blend the shades to get the best effects. Much depends upon the intensity of light thrown on the color in order to distinguish it readily. By poor color perception it by no means follows that the person is color blind. The party's mentality is liable to be the main factor in this, as in other affairs of life.

The field of visions for different colors varies widely. The narrowest are for green and yellow. The color limit, even in normal eyes, is by no means uniform. The dimness of color sense may cover the whole field, or be confined to a part that varies in size to that of a small scotoma of the retina.

We find color blindness from two other causes, i. e. first, where it is acquired from the use of tobacco and liquor in excess, and as the result of disease. The most frequent cause from disease is, doubtless, chronic glaucoma. We also find it in amblyopia, amaurosis, once hysteria. I have seen two cases where by a plugging of a small artery of the retina there was a complete loss of color sense on the side of the eye that was supplied by it. The most frequent cause of loss of color perception is doubtless due to the use of tobacco. It may be permanent or temporary. I have seen it permanent even after the patient had stopped smoking. These cases are, however, the exception. Usually by leaving off smoking the

color sense is restored in a reasonable time. Conditions vary much, however, in individual cases. Any exhausting disease is liable to interfere temporarily with the color sense. I have seen a loss of color sense in nursing

women where their vitality had been lowered during lactation. Also in typhoid fever and anemia.

Color ignorance is often mistaken for color blindness. In my examinations of railroad men I find nearly 95 per cent color ignorant. As a class they are not educated men in the higher sense. They will name the colors they

*Read at the first annual meeting. Rock Island Surgical Associ ation, Kansas City, December 3-4, 1903.

are familiar with in their business, e. g., red and green, but when it comes to the shades they are ignorant of the names. For instance, they will call pink red, and maroon red also. True it is a shade of red, but there is a distinctive name for the shade. They will pick out the shades of purple and put them together, but in naming them they call them blue. I find they have greatest trouble in naming the shades of yellow and gray. They will sometimes say that color is like that of an orange, but when it comes to the grays they are lost. I have tried to have these men teach one another, or have some women teach them, but few, I am convinced, will ever take the trouble.

Much depends, however, as mentioned before, on their mentality. If they are satisfied with their condition, and have no ambition to progress in their work, the task of teaching them is well nigh hopeless.

DISCUSSION.

Dr. A. H. Andrews of Chicago: We are here as railroad surgeons and examiners. The thing of greatest interest to us is: "Under what conditions shall we recommend a man for service, and under what conditions

shall we reject a man's application for service, or recommend his discharge if an employe?" Color blindness is without doubt a dangerous defect. Color ignorance is not necessarily dangerous; it depends upon its degree. As the essayist has said, color ignorance may be overcome, while color blindness, especially of the congenital type, cannot be overcome. But every man who is already an employe of the company, and who has been for a considerable time, especially if his service has been satisfactory, should be given a broad opportunity to correct any apparent defect in his color perception before being discharged. According to the requirements of the American Academy of Railway Surgeons, which Dr. Plummer tells us are to be adopted by the Rock Island road, we are forbidden to ask any man to name the different colThat will eliminate the question of color ignorance. We will be obliged to show him the test colors, that is, the letter colors, and we may ask him what colors he thinks they are, and then have him select all the other colors in the pack which are similar. That will eliminate the question of color ignorance, and any man who cannot do that is certainly not suitable for the railway service.

ors.

The doctor says that the switch test is the best test. I will have to disagree with him on that, because we cannot get the conditions surrounding the switch test when we are ready to use it that surround the man when he is

running on his engine. I will illustrate this by an example

which occurred in Chicago:

An old employe was sent to me for examination, and I returned him color blind-seriously defective. In talking with the superintendent later he asked me what was the matter with this man. I told him that his principal defect was that he could not tell green from brown. "Well," he says, "we are not using brown signals; we don't care whether he can tell green from brown." "But," I said, "sometimes a red color will look brown." He wanted to know how and when. I told him to take red, black and white and mix them together in proper proportions and he could get any color of brown which he de