"Progressive Medicine." A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M. D. Octavo. Philadelphia and New York: Lea Brothers & Co. No III. September. No. IV. December. 1903. Per volume, $2.50

net.

These issues complete the year, and, as before stated, give a résumé of the medical progress down to a comparatively recent date. The December volume is especially valuable, containing, as it does, Bloodgood's review of anesthesia, fractures and dislocations, and amputations. The question of the surgery of the prostate is much in evidence at the present day, and Dr. Belfield's article on the operative treatment of hypertrophy is very timely. The annual Therapeutic Referendum by Landis closes the volume.

The publishers announce that, with the new year, the annual subscription price of Progressive Medicine will be reduced from $10 to $6, and that, for convenience in carriage, it will divest itself of the heavy cloth binding. The volumes will each contain 300 pages, abundantly illustrated, and the work will continue to be issued under the same editorial management and with the same brilliant corps of contributors.

"Transactions of the New Hampshire Medical Society at the One Hundred and Twelfth Anniversary," held at Concord, May 21 and 22, 1903.

This volume as usual contains several interesting papers on medicine and surgery, notably one by Prof. G. W. Gay of Boston on "Obscure Fractures in the Vicinity of Joints."

Transactions of the Iowa State Medical Society, Fifty-second Annual Session, Council Bluffs, Iowa, 1903.

This volume contains several very interesting papers on the various branches of medicine and surgery. Noteworthy are the chairman's address in the Section of Surgery by Dr. G. G. Cottam of Rock Rapids on "Some Phases of Cranial Surgery." Also one by Dr. A. L. Wright of Carroll on Differential Diagnosis of Gastric Ulcer from Gall Stones."

DUTY OF INJURED PERSONS IN EMPLOYMENT OF PHYSICIANS.

The Appellate Court of Illinois for the Fourth District holds in C. & E. I. R. R. Co. vs. Burridge, a personal injury case, brought by the latter party, that an instruction stated the law correctly which told the jury that it was the duty of the party suing "to employ such doctor or doctors for the treament of his injuries as ordinary prudence in his situation at the time of the injury and thereafter required; and to use ordinary judg ment and care in so doing, and to select only such doctor as was of at least ordinary skill and care in his profession; but the law does not make him an insurer in such case that the doctor will be guilty of no negligence, error in judgment, or want of care, and where such errors or mistakes occur in the treatment, the injury resulting from such mistakes is properly regarded as part of the immediate and direct damages resulting from the injury. -Medico-Legal Bulletin.

Railway Miscellany.

A German physician of renown was incapacitated in a railway accident, and in consequence the royal court at Frankfort awarded him a life annuity of 17,000 marks to be paid by the Prussian railway administration.

The Volunteer Relief Department of the Pennsylvania Lines west of Pittsburg paid a total of $46,016.30 in benefits during the month of August, 1903. Of this amount $9,500 was paid on account of cases of accidental death; $12,500 for cases of natural death; $12,629.50 for cases of accidental injuries; and $11,386.80 on account of sickness.

A man, whose latest. name is William Boyle, who had brought a claim against the Pere Marquette road for damages said to have been caused by falling from a car, has confessed that the injury was received nine years ago, and that since that time he has collected damages, amounting to $2,350, from the Rock Island, Houston & Texas Central and the Michigan Central for the same old rupture.

One of the most curious causes of a railway accident is that reported in the case of a head-end collision between two trains on the Big Four road near Rose Hill, Ind., last week. A conductor received orders to meet train No. 26 at a certain point. In reading the message, it is said, he accidentally placed his finger over the figure 2 and read that No. 6 instead of No. 26 was to be passed, and the collision with No. 26 soon followed.

A mutual benefit association has been organized among the employes of the Topeka Railway. It is known as the Topeka Railway Employes' Benefit Association. The company has started the association out with a reserve fund of $200, which it will assist in maintaining. The association will pay a sick benefit of $7 a week for a period of 15 weeks in one year. an accident benefit of $10 per week will be paid for a period of 10 weeks in a year. The association will also pay a funeral benefit of $50. If the reserve fund should fall below $200 an assessment of 30 cents per month will be levied upon each member until the required amount is again accumulated.

The fourteenth annual report of the Voluntary Relief Department of the Pennsylvania Lines west of Pittsburg for the year ending on June 30, 1903, shows that during the year a total of $475,943.95 was paid in benefits. Of this amount $88,500 was paid on account of cases of accidental death, and $102,630 for cases of natural death. Accidental injuries accounted for the payment of $137,237, while $136,539 was paid on account of sickness. Bills for surgical attendance amounted to $1,157.75. There were 14,384 cases of death and disablement during the year, on account of which benefits were paid. The membership at the close of the year was 26,259, which is an increase of 3,080 during the year.

The Northern Pacific Beneficial Association, an organi zation of the employes of the Northern Pacific, which maintains hospitals, pays benefits and cares for the sick and injured, elected the following officers at the annual meeting in Saint Paul, Minn., on September 17: President, M. C. Kimberly; vice president, L. T. Chamberlain; secretary, W. A. Laidlaw; treasurer, C. A. Clark; comptroller, H. A. Gray; executive committee, M. C. Kimberly, H. M. Robertson, Newman Kline. The association has hospitals at Brainerd, Minn., and at Missoula, Mont., which are maintained by monthly assessments. The total receipts for the past year were $166,922, compared with $165,865 for the previous year. The expenses were $159,247, compared with $164,063 for the previous year. The association has a surplus of $27,674. At the Brainerd hospital 3,142 cases were treated and at the Missoula hospital Line surgeons in the eastern district cared for an additional 14,170 cases, and line surgeons of the western districts 13,834. The total number of cases treated was 33,375, as against 31,433 the previous year.

2,229 cases.

VOL. X.

No. 8

PORT.*

Dr. J. W. Chamberlin of St. Paul, Minn.: When I received a notice of this meeting I learned, for the first time, I was to open this discussion. Not having seen the paper beforehand, or knowing particularly what it would discuss, I am only able to say a few words regarding some thoughts that have come up during the reading of the

paper.

The essayist has been engaged in this work for many years, and he has covered the ground very thoroughly and effectually. I can only add a few things that have come to my personal knowledge in the work I have been doing for the past few years in connection with two or three railroad companies in the Northwest.

The essayist takes up the possible percentage of accidents by derailments, collisions, etc., that may result from defective vision. Just how many of these are correctly chargeable to such a defect we will never know, for many of these accidents result in the death of the engineers, and certainly it will never be known whether it was the result of defective vision on part of the engineers or not. This particular point was brought to my notice very forcibly about a year ago. A young engineer was sent to my office for examination by one of the railroads in the Northwest. I examined him carefully and found his vision was about 20-50 in each eye. I made my report to the assistant general superintendent, thinking nothing more about it, simply telling him that this man was incapacitated for such a position, and that was all there was to it. About three days afterward the superintendent came to my office and said, "Doctor, do you remember Mr. So-and-So that came to you day before yesterday for examination?" I replied, "Yes." "I want to tell you about him, because it will interest you. About two months ago we had a collision on such and such division, which resulted in the loss of one life, and $12,000 or $15,000 for the company. I investigated that case and had a competent man to assist me. We found everything pertaining to that train, with the signals and all that was possible for the safe running of it, were perfect. The signals were right; the brakes were right; the light was all right, and we have been entirely unable to explain why that accident could possibly have occurred. This engineer has been away for sixty days on a leave of absence, and it was the only accident he ever had. I suggested that he had better be examined before taking

*At the tenth annual meeting American Academy of Railway Surgeons, Chicago, October 1-2, 1903.

Now, the point I wish to make in relating this circumstance is this: Had that engineer been killed in this accident, the cause of the accident would never have been known, as we may deduce from that certain conclusions, that many accidents perhaps that are entirely unexplained and are unexplainable in any other way are due to defective vision.

Dr. Allport has outlined and emphasized the necessity and importance of carefully examining employes entering the railroad service, and he has dwelt at great length upon the concessions which should be made to men who have been long in the service, with all of which I most heartily agree. I would be more explicit in determining hypermetropia, because I have had to run against that so often in the handling of old employes, and I have made it an invariable rule that every man who is examined, who has anything to do with the train service, shall be examined in this regard in a way that he does not understand so that he can be tricky. It is just as important a part of the examination as that his visual acuity shall be taken, or color sense. If we proceed along these lines, in a few years we will have eliminated from the train service a class of men who are dangerous, and who are now quite a large percentage of the train operators.

There is one thing that came forcibly to my mind, namely, the locomotive engineer will never admit he can wear out. If a man is 65 or 70, he thinks he is just as good a man for the train service as he ever was in his life, and just as good as any other man, no matter what his age or qualifications may be. To a few of these men, who are intelligent enough to understand and talk to, I have communicated my ideas on this subject. In professional life, when a man gets old, his place has to be taken by somebody else, and is there any more reason why the locomotive engineer should be exempt from the changes which take place with time, and why he, when he begins to act old, should not give way to someone who is younger? While I am heartily in accord with the essayist in making concessions of this kind, and while I do it every week of my life, still there is that one amazing point to me, that the locomotive engineer thinks he can never wear out.

So far as the general adoption of any certain, welldefined rules with the different railroads is concerned, in my opinion the men who are at the head of the examinations are the men who should have that in charge. With the railroads with which I am connected there

is no question about my judgment in the matter. The question is referred to me, and I decide it. There is no superintendent or general manager that says we had better do this way or that way. We must be careful and try not to tread on anybody's toes. I have been waited on by grievance committees from the locomotive engineers and firemen, they asking me to be absolutely fair in my decisions. They have come to me with statements in regard to certain men, saying that this or that man was capable of doing his work as well as anybody, and that he had worked somewhere else and had done certain things. When I have put the question to them fairly and squarely and told them that I could easily demonstrate that the vision of this or that man was not up to the standard, etc., there has not been a single man but who has left my office agreeing that my position in the matter was fair and right.

If each railroad has an ophthalmic surgeon at the head of it, he should familiarize himself with all of these reports, and look into the matter carefully and advise for that road what it should have. He should be familiar with the operation of the same systems or similar ones on other roads; he should consult Dr. Allport's report, and if he is wise he will adopt it, and if he does that he will be working in harmony with others, and when a man comes off from the C., B. & Q. on to the Northern Pacific he connot be employed, if he has been discharged from the Q. road. I have been told by men connected with other systems that we were slow in getting around to that in the Northwest; that the Pennsylvania has done better work in that respect, and that we have been siow about it. I have been told by men from other systems that they could not get employment on the Illinois Central, on the C. & N.-W., or the Pennsylvania, but that when they came to the Great Northern or the Northern Pacific they were almost sure of a position without much questioning. This has resulted in a good many men getting into the service of these roads that could not get in to-day. Those are the men for whom we have to make concessions, as has been outlineed by Dr. Allport. I am glad of the opportunity to have listened to such an interesting and exhaustive paper. I have read most of the work before, but it is fresh in my mind.

There is one thing that I regard as being almost a necessity which was touched upon by Dr. Jennings in his paper, and that is the identity of the men who are sent to the oculist for re-examination. On the road with which I am connected if a man is dissatisfied with the examination he receives on his division, he is privileged to go to me, or if I am dissatisfied with the report I can order him to be re-examined by myself. I have had it happen on about four different occasions where a man, who was manifestly incompetent, whose vision was bad, came to me with a letter from the superintendent which he never presented, but which was brought to me by someone whom he got to take the examination for him. Of course, when the record of his supposed examination had been passed on by the division. to which he applied, if he overdid it, if his vision was altogether at variance with the other one, I have taken pains to inform myself before I completed his examination, and I have never failed to find out just exactly

I make it a rule to have

where they were standing. every man sent in to me identified by his signature. The superintendent sends me a letter by mail enclosing the signature of this man, and the other man is given a letter which he brings to me. In that way I can detect impositors as they come, and they are "foxy." Some of them are acute about it. I regard that as being an essential feature in connection with these examinations.

Dr. A. H. Andrews of Chicago, Ill.: I want to endorse the paper read. I shall not go into details on the subject, though I desire to mention one thing that was not touched upon in the paper, and that is the necessity for rapid vision. A man may be able to look steadily at a letter and finally name it correctly, whereas if asked to name it quickly he will miss it.

Not long ago I took a ride on the engine of one of the fast trains, and I was impressed with the necessity of an engineer being able to see quickly. If you will test the men who come to you for examination, you will find that a great many of them, whose vision is slightly defective, are not able to see quickly.

I have seen nothing in print on this subject, but I think all of us should give it more attention. I believe the time will come when we will have tests for rapidity, as well as for acuteness, of vision.

Dr. J. E. Minney of Topeka, Kan.: That is what I alluded to when I spoke about uncertain vision, and I have had occasion more than once to turn a man down because of uncertain or slow vision.

I ought to have said, first, that I am highly pleased with the report of Dr. Allport, and I can only confirm. what he has said.

Regarding the watch, I think it is a very poor, uncertain test, and while we use it, yet we use all the other tests, the tuning fork, the voice and whisper in connection with it, and many cases pass our examination who cannot hear the tick of a watch 5 or 6 inches; that is, old employes, not the new ones. You will find, I think, the watch is one of the least reliable tests that we have, and yet some place great stress upon it.

Respecting the old employe, I see some here whose hairs are getting gray as well as my own, and we feel that there is a liability of a mistake being made through sympathy, yet we must trust to judgment. Eighteen years ago, when I was first appointed on the Santa Fe Railroad, I asked the chief surgeon this question: Shall I consider in my examination of these older men the record of that engineer; that is, whether he has had accidents, how many, etc.? Shall I consider his intelligence, although he may be up to the standard, etc.? He replied, "Yes, if they come up to the standard, but use your own judgment," and I have done so from the beginning and have had no occasion to regret it.

Just as I left Topeka yesterday I met an old engineer, 66 years of age, who has one of the best records on the Santa Fe system. He runs from Topeka to Atchison. The train was forty minutes late. He said to me, "We are late, and they expect me to make up the time on the road; I know where the bad places are; I won't do it." And when I said to him, "Are you not afraid of being discharged?" he replied, "No; I am doing my duty." He is at work and has had fewer accidents

than the young men. The intelligence, the experience and record of that individual should be considered, and yet we are liable to overstep the bounds because of our sympathy.

Respecting the whisper, we make it a rule that applicants must hear a whisper 20 feet distant with the lips of the examiner from the patient. I think the point should be remembered not to look at the patient, but have him look at you (the examiner), and whisper to him, and see if he can hear you at that distance. The lips of the examiner should be from the patient, and he to hear the ordinary whisper, at least 20 feet. That is the method that we should resort to in making the examination, with one ear closed, the patient standing sidewise to you.

I think the ophthalmoscope can be used with advantage in examining those individuals that are about to be employed. Of course, if you cannot use the ophthalmoscope, the essayist has spoken of a method that may be used. But the ophthalmoscope is of great value in these cases. Often we are able to determine a high degree of hyperopia, and either exclude a man or have him come back for a re-examination,

One word concerning the old engineer. Those of you who have been in practice for ten or fifteen years, from your own experience, know very well how it compares with when you first began the practice of medicine. A patient comes to you, and you try to find out what is the matter with him, and how many times have you been mistaken? Now, this work you can do more rapidly, accurately, definitely and to a certainty. It is the same way with the old engineer, and that is why I make a plea for him in that respect.

Dr. Chamberlin: As the report of Dr. Fairchild bears on this same subject, would it not be well to have it read, and then the discussion continued on both the paper of Dr. Allport and this report?

There being no objection to this, Dr. D. S. Fairchild then presented the report of the Committee in Regard to the Examination of Railway Employes.

Dr. John E. Owens of Chicago: It is a very difficult matter for me, at least, to discuss the merits of Dr. Allport's paper and the report that has been submitted by Dr. Fairchild. The paper of Dr. Allport is a comprehensive and valuable one for all of those who are interested in this work. I cannot discuss the report handed in by the Committee of the Academy because I do not remember the details. I cannot carry them in mind. I suppose that many of you know the railroad companies themselves have taken up the matter of uniformity of requirements for railroad service; I mean some of the chief officers of the railroads, who are not professional men, and a copy of their report I have just received from a member of the committee, but I have not had time to look it over.

We have been considering for some little time a more liberal requirement on the Northwestern Railroad in cases of old employes, but have not yet reached a decision. I thought I would wait until I had the report of the Academy's committee, also Dr. Allport's paper, and I am not yet able to say just what I shall do in the matter. It seems to me, however, it is a subject for proper consideration by those who are interested in this work.

We should have printed copies of both these reports and quite a number of them, so that we can be brought face to face with the matter, and more intelligently consider its merits and decide what we ought to do. It is one of the most important subjects that has ever come before the Academy, and deserves much more consideration than we can give it here to-day.

Dr. J. E. Minney of Topeka, Kan.: I think these reports are a good working basis for us, and if we wait until we have everything correct, we will never have a report made. I am certainly in favor of having these reports printed, and let us use them as a working basis. I want to switch off for a moment, to speak of an interesting case that came up for examination about two years ago to me. It was the case of an engineer who had an accident. His eyesight was perfect, each eye was 20-20; everything appeared to be normal, yet he had an accident and was sent to me for examination. I took him into my examining room, lit a lamp, and put a prism over his eye. After testing him a little while. I said, "You have double vision." He said, "How did you find it out?" I replied, "We oculists know how to find it out." It turned out that this man had double vision only when he was tired or overworked. He had been overworked, and he admitted, after it was found out, that he had double vision when he became very tired. This is an important matter, and it is the exceptional cases we want to consider. I am in favor of the reports of these committees being published and sent out to us as a working basis.

Dr. A. B. Brumbaugh of Huntingdon, Pa.: I recall the case of an engineer who, in approaching a light, said it was green, while the fireman said it was red, and while they were discussing the matter both had to jump for their lives, there being forty-two cars piled up with freight. I would like to ask Dr. Minney if that is due to double vision or to a tired condition of the eye. Dr. Minney: They were deceived by the color. Dr. Frank Allport: We have with us one of the most experienced gentlemen in the United States in regard to these matters-Mr. R. C. Richards, of the Chicago and Northwestern Railroad Company.

Mr. R. C. Richards (general claim agent, C. and N.-W. Ry.) of Chicago: I have had some experience in relation to the matter of examination of employes, because I believe the Northwestern was one of the first roads to undertake these examinations in a systematic way. Unfortunately, I did not get here this afternoon until the greater part of Dr. Allport's interesting paper was read. I only heard the last part of it, and I did not get the benefit of the first part of it.

I

This matter you have under discussion is the most important that has ever come before the Academy. think it is more important to the railroad that they have good men who can see and hear than to have a good track and equipment. If you have good men, you can get along pretty well with a poor equipment, but if you have poor men you are always in trouble.

The American Railway Association, composed of the managing officers of the United States and Canada, have had this subject under discussion. The report was sent to me some time ago, and the question that has come before that association, and will be finally decided by

the railroads, is the very one you are now discussing, that is: "What is the very least normal vision, hearing, and color sense that it is safe for the railroads to employ?" I think, if you do not do anything else at this meeting than to adopt this report which is founded on theory as well as practice, one which can be followed by the railroads, you will be doing a great thing for the railroads and for the country, and I do not believe you can give too much time to the discussion of this matter so as to get it right, so that when your recommendation comes to the American Railway Association, it will in all probability be adopted. Of course, we all know that railroads are paying higher wages for this class of work than any other industry or concern in the country; therefore, they are entitled to the highest degree of intelligence and physical ability. I do not think you should let the bars down. If there is going to be any change at all, you should raise them, because we all know that ordinarily, when these things come up for final decision, there must be some compromise, and you had better have a little room to trade on. The more you consider this matter, the more important you will find it to be, and the more necessary it will be to have these instructions and recommendations made right. Considering what little I heard of them, it does not seem to me you have got them too high. You must have the standard high. If you will put this matter in such shape, so that it will not have to go over until some other meeting; if you will adopt it in some form, even though you postpone it until to-morrow, you will be doing what I consider the proper thing.

Dr. Frank Allport: I want to say a few words regarding the report brought in by Dr. Fairchild. As I understand the report, there is nothing said with regard to color blindness, or as regards excluding men who are color blind. This report has been made somewhat on the basis of the report of the House of Delegates of the American Medical Association, and that report, as I pointed out in my paper, while it mentions color blindness, it says certain tests should be used in color blindness; it does not say men shall be excluded who are color blind. Is that right?

Dr. Fairchild: We assume that all men who are color blind are excluded.

them latitude, one eye being better than the other, vision in one eye being 20-30, in the other 20-40.

Dr. Owens: What would be the reduction? Dr. Allport: I don't think there would be any appreciable effect on the acuity of vision.

Dr. Owens I have been informed, and have understood, that after long runs on fast trains, visual power of engineers becomes somewhat reduced temporarily.

Dr. Allport: That, I presume, is true to a certain degree; but I think vision, as ascertained in the office, should stand without regard of some possible physical fatigue after taking a run.

In the report presented by Dr. Fairchild nothing was said, I believe, about hypermetropia. Those of us who are dealing with various forms of defective vision and correcting them by glasses feel the importance of that point. You find that always mentioned by men who devote special attention to the diseases of the eye. It does not appear to the ordinary railroad surgeon that a man who may have vision of 20-20 is admitted, and nevertheless have hypermetropia of 1⁄2 D., which, as he gets older, the strength of the ciliary muscle cannot overcome. Shall we exclude such men from advancement in the service? There are a number of points, it seems to me, which should be considered, and acting upon the suggestion of Mr. Richards, which I think is most pertinent, if this academy does not do anything more than to adopt this report, it will have accomplished a great mission, and I would therefore suggest that this committee be continued until to-morrow, so that the members can consider carefully the various reports before acting quickly and harmonize any discrepancies that may exist. and bring in a report to-morrow. I would make that as a motion, that the committee be continued, and requested to bring in a perfected report to-morrow.

Dr. H. C. Fairbrother of East St. Louis, Ill. It occurred to me in listening to the report that if it was defective in any particular, it was not sufficiently explicit in regard to hearing, distance vision and color vision. A man may hear the tick of a watch at 36 inches with one ear, but only at ten inches with the other. This ought to be considered in the report, and whether we should turn down such a man or not. The same applies with regard to distance vision. A man may have nor

Dr. Fairchild: The preliminary report here requires that a man shall have normal color vision. I take it for granted that there is no exception to that proposition, but it is simply a question of visual capacity.

Dr. Allport: Another thing Dr. Fairchild speaks of is with regard to old employes having 20-30 vision with both eyes singly, and they shall be allowed to wear glasses to bring vision up to the proper standard. In my experience. I find a great many old engineers whose vision can be brought up to 20-30 in one eye, but they cannot get any better than 20-40 in the other eye. While we wish to raise the standard, it seems rather a hardship to fix vision at 20-30. If a man does not have 20-40 in one eve he should be excluded; it would be better and it would meet the approbation of railroad officials if they understood the matter in a higher degree, if we give

with one eye, but not with the other. Shall we turn down such a man? Again, shall we shade at all the matter of color perception? The report ought to touch on color defect as distinguished from color blindness. Color ignorance also is important.

Dr. Owens: This matter of whispering is not very clearly understood. I believe in Dr. Allport's paper he mentioned hearing a whisper at 10 feet. In our examinations on the Northwestern and the Illinois Central I have been subjecting applicants to a coarse whisper at 20 feet, or ordinary conversation. I discussed this matter with Dr. Allport a year or two ago, because the ordinary conversation of a large, big-chested man is different from the ordinary conversation of a man of smaller size. And so in some cases an ordinary conversation may not be much better than the watch. much better than the watch. We have to depend upon the size of the watch entirely. I more frequently rely