my care led me three or four years ago to place prepared antiseptic pads in almost all the factories and shops in our city, and I have been well pleased with the results attained from them thus far and believe it. will be to the advantage of every factory, machine shop, foundry and railroad to equip their offices with a box of the dressings such as I am about to describe. In order for a First Aid dressing to be of any use it must be at hand where the men work, simple and easily applied by fellow workmen, and so arranged that it can be kept sterile.

Most of the boxes supplied by the railroads are absolutely worthless. Made up as they are from material in bulk which is to be cut off and used by unskilled hands as they are needed; usually accompanied by a small drug shop, and a large amount of directions for treating the injured fellow, and it is surprising how complete some of these treatises are. This is all nonsense; a workman has no time to study a text-book on antiseptic surgery before attending to the sufferer. The only things that should be done to his fellows are to stop dangerous bleeding, cover the wound and protect it from further injury; usually the less he does, the better for the patient. The pads are prepared as follows: Four thicknesses of gauze 8x10 inches are laid on a pad of cotton a little larger, say 10X12 inches; over the face of the gauze is spread 2 or 3 drachms of some non-toxic, antiseptic powder, usually boric acid and acentanilid, or Senn's salicylic and boric acid powder. The pad is now folded together so as to hold the powder in the center wrapped in waxed paper and closed in envelopes or cartons, then packed in a suitable box. This is the smaller sized pad, and is sufficient for injured hands or feet, or small lacerated wounds on the extremities. A larger package is made in the same way, only three or four inches larger each way, to be used in compound fractures or dislocations, or in extensive injuries to the head or trunk.

One or two dozen of each sized pads are packed together in a suitable box, with a dozen each two, three and four inch bandages and three one-yard rolls of picric acid gauze. On the lid of the box should be a cut of a "Spanish windlass," and very brief directions for its application to stop hemorrhages; also directions like this. on each package:

"Cut the clothing from wound, open package of dressing and spread powdered surface to the wound and apply bandage to hold it in place." On the picric acid gauze. jars should be printed:

"For burns-Wrap the burned surface with the picric acid gauze and apply a bandage over it. Do not touch the burn with anything else."

This is enough, and anyone can understand and follow it.

I have written the manufacturers for prices, etc., and find that three dozen pads, bandages and picric acid gauze, all in a neat box, can be retailed at about $7.50. Such a box will pay for itself a dozen times the first time it is used properly on a severe injury.

DISCUSSION.

Dr. Williams, Ottumwa: I think this matter of emergency dressing, which is just starting among factory men and railroad men, is an important one. It is teaching them the sine qua non of surgery-cleanliness. It is

astonishing how it has spread all over the country that you must keep dirt out of wounds. People say: "Doctor, are your hands clean?" Now, as to just what these dressings should be, it does not make any difference, so it is something absolutely clean; and the factory hands are beginning to understand that, and beginning to understand that all these packages must be kept out of the way of dust and dirt.

Dr. Deering. If you want something simple, why don't you put on the simple gauze and be done with it? Just plain, clean gauze is all that is indicated, I think.

Dr. Plumbe: I guess that most of the gentlemen present will concur with me when I say that there are no classes of injuries that are so liable to be septic in their rature as railway accidents, or general emergency surgery cases resulting in machine shops and places of that kind. A good many years ago, before we had these automatic couplers, I had from early fall to spring an average of three a month, and sometimes as many as one a week, of fingers, thumbs and hands to dress and attend to. Fortunately, for a long time I had nothing very serious, and in those days they would come to you with all manner of dressings on an old, greasy jumper wrapped around the hand, or a handkerchief, maybe, with a lot of tobacco on it. At that time I strove to impress on the brakemenparticularly the brakemen and conductors-the necessity of keeping those things clean, and the best suggestion I could give them for a dressing was to use what all of them have, and all of them carry around the engine and caboose-good, clean waste; tell them to not do anything to it, but just simply to wrap it up in good, clean waste until they would get to where it could be cleanly and permanently dressed.

Now, this question of emergency cases is a question that has just come up in the last few years among railroads and factories, and the point has been and still is, to get a good, cheap antiseptic dressing that could be applied by employes themselves until they could get to the surgeon. The gauze I never get in anything but yard cartons, for the reason that when I open it and use a piece, I throw the rest away. The trouble has been, as Dr. Brockman has said, the amount of gauze and dressings sent out by supply houses in these cases is too large. No railroad man can open a yard carton, cut off a piece and put it back and have it in condition to be used on another patient two weeks hence. Another thing is the cost of them; that is one trouble with the railroad companies, one reason why they do not give us these emergency cases on cabooses and engines and in the shops. It would cost no small sum to equip every caboose and every of a passenger train, and for that reason they do not do it. The railroad companies are not in business for their health, but at the same time it would be a benefit to the employes if it could be done. I never travel or go away from home without instruments, cocain, tablets of morphin and antiseptic tablets-generally find plenty of whisky in the crowd. The case that I carry is very small, containing a pair of forceps, scissors, hypodermic syringe, needles and enough antiseptic powder to dress an ordinary wound. It requires but a small space to do all that, and I think it is the duty of the surgeon to go prepared whenever he goes away from home. And I carry, besides,

coach

something to take cinders out of eyes and a few tablets of cocain, and very frequently have to use them. Only yesterday I did up a man's finger and sent him to Sioux Falls to the surgeon of his company.

Dr. Clark: I am sure that Dr. Plumbe's ideas for the care of injured people will commend themselves to every surgeon here. We ought to profit by his way of doing things and his experience. However, when he tells us that he is in the habit of throwing away unused packages of gauze because after the package has been broken it is unfit for use, he is attempting to teach inexcusable extravagance. Extravagance that most of us cannot afford. Some of us have learned that there is such a thing as resterilizing dressings, and know just how to do it in order to make them perfectly safe. I wonder why the doctor has not learned this.

Dr. Plumbe: I will say to Dr. Clark, that when I can buy a yard of gauze now for about 10 or 12 cents, or 8 cents, I want to know I am getting it from somebody whom I know furnishes absolutely sterile gauze. I do not feel like bothering with it after I cut off six inches. or a quarter of that yard. I would rather go and get another yard that I know is all right.

Dr. Brockman (closing discussion): I think there has nearly enough been said. I am never surprised when I hear a paper read on some advancement in surgery to hear someone behind the times get up and bring up some old treatment that has been obsolete for years. It reminds me at once of the story I heard some time ago of people that did not believe in advancement. An old gentleman and his wife went to see the train come in. They had never seen a train, and they got there after it had reached the station. They went walking along hand in hand looking it over. Presently the bell rang and the old man looked at the engine, and he said: "Mother, they'll start 'er." Pretty soon again the bell rang, and the engine. started off, and they trotted along the side of the train a ways, and she says: "Pa, they'll never stop 'er."

For a railroad surgeon to talk about wet dressing for fresh wounds to-day is startling. I did not expect it. Neither did I expect waste to be recommended, or tobacco, or anything of that kind. I feel that the little squib I read to you was needed for this association. Nor do we need postage stamps to cover up wounds. Unfortunately, wounds are not made with penknives. The wounds we see about packing houses and factories and railroad shops are hands and other extremities crushed all to pieces, and we do not want a postage stamp on them, and we don't want tobacco on them. We want the wound swathed in an antiseptic preparation; not only an aseptic, but an antiseptic preparation; something that will kill the germs, or that will hang the germs up that are on the skin around that wound and present asepsis. I do not see what harm it will do to put so voluminous a dressing as 10 or 12 inches around that hand. I know it will be no use to put one 3 or 4 inches over it. If a compound dislocation or a fracture has happened, it needs a larger dressing (say, from 14 to 18 inches), that will spread over it. If we have a large lacerated wound, such as we are having all the time, occasioned by our modern machinery, we want something that will cover and protect. That was the idea of this dressing. It was not intended

for a joke, something to make-believe to protect, but to get it to the hospital or surgeon as nearly aseptic as possible. Dr. Deering does not believe in powders, but I apprehend that Dr. Deering believes in powders in surgery. We do not expect to kill all the germs with this, but we know that we prevent an increase of them if the dressing is put on dry. Certainly we ought to have learned by this time to put dry dressings on injuries.

you.

SOME THOUGHTS ON FIRST AID.*

BY H. SNEVE, M. D., OF ST. PAUL, MINN.

I assure you it is a great pleasure for me to meet with The Great Western considers itself a citizen of Iowa, and I suppose the surgeon representing it can also feel that he is a citizen of Iowa. It is an imposition, however, to appear on your program, as I have both last year and this, for a talk without announcing any paper, and to come here to-day without a paper, and with a few rambling thoughts, which are chasing around through the cortical cells of my brain.

I had intended to say something about First Aid instruction to employes, and discuss the question with you, hoping to bring out your views in the discussion, and possibly learn something as to whether we are doing. right in trying to teach our railway employes to render First Aid to injured persons. Whether it is not trespassing ing ourselves an injustice, by getting a lot of men to upon the rights of the doctors of the community, and doput on tourniquets and apply various kinds of dressings. and adjust fractures before the surgeon arrives, and various other questions connected therewith. I think the question will resolve itself into two main issues:

Railroads running through territories where doctors are not convenient, or are located at considerable distances apart along the line, and railroads running through territories like Iowa, where there is a doctor every 10 miles. In the first class I do not think there can be any difference of opinion as to the value of instructing employes to render some First Aid. But in a state like Iowa, where surgeons are many and good, it seems to me that we are really trespassing, infringing, on the rights of physicians and surgeons and doing the injured person an injustice and a wrong to allow some layman to apply a

tourniquet.

I have had personal experience with a number of cases that have received First Aid from some of these men who have had instructions, one resulting in gangrene following the application of the tourniquet for the purpose of stopping bleeding, and the other a case where it was applied without skill and was useless. Fundamentally, it

seems impossible to teach a layman in a few lessons how to render proper First Aid. Perhaps the best we can teach them is what not to do. As far as hemorrhage is concerned, we know that nearly all the injuries resulting from railroad accidents are of a crushing nature, so that the application of tourniquets is not indicated; and then comes a question of straightening the legs in case of fracture, etc. The manipulation performed by these men, my experience has been, has tended to render the *At the annual meeting Iowa State Association of Railway Surgeons, Des Moines, Oct. 17-18, 1903.

fracture worse, and in one instance that I know of, to render a simple fracture compound by well-meant efforts to produce a proper setting of the bone for the doctor before he arrived. I think it much better to leave these patients alone. The intention is, of course, humanitarian. It is the desire of everybody to render aid to the afflicted and sick, and the idea of this First Aid is one that appeals more particularly to the layman than it does to the doctor. About all the benefit to the medical profession is that it affords some of our new railroad surgeons a chance to give instructions to men in shops and employes along the line, which will help advertise them. This is all right, but, as I say, in these populous communities, it is absolutely unnecessary, in my opinion.

IMPORTANCE OF SYSTEMATIC INSTRUCTION OF RAILWAY EMPLOYES IN RENDERING "FIRST AID."*

BY M. J. KENEFICK, M. D., OF ALGONA, IA.

The importance of instructing railway employes in the necessity of attending promptly and properly to apparently trifling injuries was recently brought to my attention by a case I was called upon to treat last month.

A freight conductor on the Iowa Central, while unloading a hay-stacker, had the fleshy part of his thumb penetrated to the depth of about 1 inch by a small sliver. He removed a small portion with his jack knife and applied the customary first-aid antiseptic dressing-wellmasticated chewing tobacco-and resumed his work. A few days later he called at my office, complaining of pain in his arm, extending to the elbow. After applying a somewhat different style of second-aid dressing he was reported off duty and sent to his home in Oskaloosa for a third-aid dressing. This conductor was off duty for 18 days on account of a trifling injury which should not have incapacitated him from attending to the duties of his position for a single day, had his injury been promptly and properly attended to.

It would be interesting to compute the loss in dollars to all the railway companies in this state occasioned by just such cases as this, which is typical of a great number of cases coming annually under the observation of the local surgeons. The prevailing ignorance among railway employes regarding the treatment of wounds is not different from that which we encounter in general practice among the laity. We, as a profession, attempt the almost hopeless task of instructing the public in the prevention of disease, especially instructing them how to avoid infectious diseases. We have accomplished much good in the past decade or two, especially among ignorant midwifes, in lowering the death rate from puerperal infection. How much more good should we be able to accomplish among a well-organized body of men like our railway employes, all of whom, down to the section foreman, are sufficiently educated to at least read and write the English language? The local surgeon may tell the injured man and his companions that they did wrong to bind up his wound with a dirty pocket handkerchief, but the harm is done, and these men should have been told Reform along why this was wrong before they did it. *Read at the annual meeting Iowa State Association of Railway Surgeons, Des Moines, October 17-18, 1903.

this line will come very slowly if left to the local surgeons. Education here, as elsewhere, to accomplish most good should be systematic. It should extend from center to circumference, from above downward.

It is not the purpose of this brief paper to volunteer advice to the chief surgeons, but the local surgeon should be exonerated from reproach, too often brought upon him through circumstances entirely beyond his control.

So far as the writer is aware, no organized effort by any of the roads traversing this state has ever been made. to give proper instruction in first aid to employes. For the purpose of securing reliable information on this point I wrote the chief surgeons of the most important roads in the state, and received the following replies, which I take the liberty of quoting:

Dr. Denney of the C., B. & Q. replies: "We have at certain points on our lines, but at many places, where doctors can be had on short notice, we have not been paying much attention to this, excepting at some of our larger division points."

Dr. Plummer of the Rock Island says: "There has never been any instruction in first aid to the injured given to the employes of our road. We had a limited number of the emergency boxes containing dressing suitable for first aid in our trains and in some of our stations, but the management of the road has seen fit during the last year to cut down our supply of them, so in the matter of first aid we are doing practically nothing at present."

Dr. Bouffleur of the Chicago, Milwaukee & St. Paul writes: "I am sorry to have to reply, No! Some of the earlier attempts on other roads were so unsatisfactory that some of our officials do not believe it practicable. A scheme of limited first aid is being considered, and will, I am sure, be of much service when fully inaugurated."

Dr. Owens of the Chicago & Northwestern answers: "There has been no systematic instruction in first aid." Dr. Sneve of the Chicago Great Western replies: "No; only to foremen at shops."

Corporations like railways, organized and conducted primarily for profit to stockholders, are not likely to take kindly to any suggestions for reform unless it can be shown that there is a business side to the proposition. There should be no difficulty in showing that there is a great loss annually of time and money to the roads by reason of improper aid to injured rendered at the hands of uninstructed employes. It would seem that when valuable information can be readily disseminated without cost to the companies, it should be cheerfully accepted. The chief surgeons could easily agree upon an outline of instructions or prepare a manual which could be used as a textbook by division surgeons in holding schools of instruction at division points where the men can easily be reached. The division surgeons, I am sure, would gladly give one hour a week to this sort of missionary work. We observe in all cabooses and passenger cars certain rules for the instruction of employes and the public, issued by the officials, but I have never yet observed a card of instructions issued by a surgeon for the guidance of employes in accidents or emergencies. This instruction, to be of the greatest value, should be practical. and it should be universal. The surgeons in charge will attend to making the instruction uniform and practical,

if the management of the roads will attend to making it universal, by making it obligatory upon all employes, from superintendent down to section foreman, to inform. themselves in such elementary principles of surgery as the chief surgeons may deem proper.

DISCUSSION.

Dr. Van Werden: I am glad, indeed, that Dr. Sneve has given us his views, as they certainly will be appreciated by all. I think they are in exact accordance with the conclusion arrived at at the Claim Agents' Meeting in New York. Now, there are objections offered to First Aid, but I believe only to certain features, not as a whole. That is like all other questions, there are certain matters that one can discuss pro and con. The tourniquet, I do not think should be used by anybody but a surgeon. I do believe that there is great good by First Aid with certain limitations. I believe that infection can be avoided in many cases, and we can have union by first intention, and quick results if all insist on placing the cases in easy fitting adjustment, and it will make it less ex-. pensive for the railroad, and shorten the time to recovery. The application of any clean cloth, or cotton or antiseptic powder, that might be in First Aid package, is certainly an advantage. It can be no harm in any way, that I see, if simply placed on loosely; or if in a case of fracture. a simple blanket bandage (or a blanket splint, rather) can be made, and the limb held in that and protected, giving great comfort to the injured, and certainly bringing them to the surgeon in much better condition. The amount of confusion or amount of hemorrhage is lessened, and the results are far better than where they are neglected, or where dirty clothing is allowed to lie next to the injury or wound. The simple application of a bandage and a dressing that are handy can be made by anyone in a way that will make matters better. Of course, a bandage can be properly or improperly applied, either by a surgeon or layman, but the wound can be closed from external contamination. I believe there is a certain amount of aid and care which can be applied, by railroad employes, and that good can come from instruction limited to a few simple preliminary matters that they certainly can understand, and can perform in their way to the advantage of the patient.

Dr. Brockman: This is along the line that I talked about yesterday afternoon, I cannot help but believe the less instructions the men have the better it is for them. There are two or three elementary principles that should be understood by a fellow workman, which can be taught them in five minutes. As I said yesterday, to stop hemorrhage and cover up lacerated wounds is about all fellow workmen should try to do. A little simple First Aid pad, which, as I described, will be useful if the laceration is extensive. Get your wound covered up as quickly as possible with this. If we will teach the fellow employes to elevate the limb, if it is a venous hemorrhage, that will check it without putting on a tourniquet. Now, with all due deference to Dr. Sneve, I am going to oppose the idea of employes never putting on the tourniquet. More men die from hemorrhage than there are limbs lost from gangrene. I would never allow a rubber bandage put in a First Aid package. There is not one case in a hundred that needs a tourniquet before

it reaches the surgeon; but there is once in a while a patient that will bleed to death before reaching a surgeon where, if a Spanish windlass be applied and taken off occasionally, and if it still bleeds replace it. This is not difficult to teach men to do; that if a wound persists in bleeding after elevating it for five minutes, they must not let that patient die, but should put on a Spanish windlass. I do not believe in putting out any treatise, pamphlets or books of instructions for employes. The more concise and brief those instructions are, the better for them.

Dr. Plumbe: I think this whole matter of instructions to employes can be summed up in just two or three words. That is, keep these injuries clean, and let me say here that you would be surprised to see how far the general public is advanced in that line. That was mentioned here yesterday in regard to the infection of wounds. Now, I was struck with that last January. One cold morning we had a wreck four or five miles from where I live. We had a freight conductor who received a rather severe scalp wound, no injury to the skull, simply a severe contusion; and I summoned a barber to shave the scalp in order to apply a dressing. I was surprised when I heard the patient ask the barber, "Is your brush clean?" "Yes," he replied, "I disinfected it before I brought it down." The patient said, "All right; but if it ain't clean, I don't want you to put it on at all." I say, the point is to get employes to understand to keep these wounds clean. Now, some gentleman objected because I advised the use of waste, but that was a great many years ago, when we had a great many more conditions to contend with than we have now, and I did that because very frequently, as every surgeon in the house knows, you would have these hands and fingers wrapped up in an old dirty handkerchief or cloth, and really were in worse condition that at the time of the injury. Now, I say they were advised, if they had nothing else, to use a little clean waste. There is certainly no infection about waste, such as they use for wiping engines, cleaning lamps, etc., provided it was clean.

I do not believe in putting the tourniquet in the hands of employes. There may occasionally be a time, and about 1 in 10,000 in railway accidents where one is needed. As Dr. Sneve has said, as a rule, these railroad injuries that we have are crushing injuries wherein the blood vessels are in such a condition that there is absolutely no hemorrhage. At the same time there may be some. I recall a case that happened to me now nearly thirty years ago when I was surgeon for the old Chicago, Dubuque & Minnesota Railway. A man was run over about eight or ten miles from where I lived, and had his leg taken off between the knee and hip. The leg was absolutely taken off, and there was a large bloodvessel that spouted and spouted, but the conductor had sense enough to ligate it, and he did a very good job, too. He got a piece of fine twine and by some means or another he succeeded in getting that vessel ligated. Now, there was no harm in having that vessel ligated. By ligating it he probably saved the man's life. That is one instance, and that is one instance in a thousand. You might have a dozen of those accidents, and have practically no hemorrhage except capillary oozing from

the vessels. As I say, this First Aid to employes can be summed up in two or three words-keep the parts clean. Dr. Thompson: I think that, if the railroad companies of this country thought the teaching of First Aid would do them any good, they would certainly have it done. The chief surgeons are the men to advocate First Aid if they think it necessary, but so far as I know there is not one of them advocating it on any of the lines that cross Iowa to-day. The matter of covering up a wound and preventing infection is all right, but I think ninetynine times out of a hundred the infection is on the skin, and is carried into the wound with the crushing injury at the time it is received. A little hemorrhage from the wound will certainly cleanse it to a certain extent, and prevent infection. So I do not think it is necessary to stop all hemorrhages that occur in a wound of that kind. And, I think, with Dr. Brockman, that the pads would be all that is necessary. The powder he uses would certainly be all that is necessary to destroy what little infection could be carried in. Putting on the wet or dry dressings to cleanse a wound by the laity I should certainly object to at all times. I also think the least instruction we give to the layman in First Aid is the best instruction. Why, they have carried the matter so far as to say the laity should have a hypodermic syringe, morphin and strychnin tablets, and be taught how to use them! There are a great many of our fraternity who are puzzled at times as to how to use them, and how could they expect to teach the laity in one or two lessons the use of such deadly weapons as the hypodermic syringe?

Dr. A. O. Williams: I think my experience in railway surgery has been as great as that of anyone I know of, and, I think, perhaps, that I have handled as many crushed limbs and as many serious railroad injuries as anyone. My experience in that line has been indeed very extended, and I really cannot recall a single death which has ever occurred from hemorrhage. There have been some cases in which the hemorrhage was, perhaps, too great. There have been some, possibly, in which it was sufficient to occasion shock to such a degree that the life of the individual was jeopardized, and there is no doubt that could a tourniquet have been intelligently applied at the right time and with the proper force, a great deal of good would have resulted therefrom, and yet the tourniquet indiscriminately used I would look upon as a serious danger, and the question to my mind is this: Would it redound to more good or to more harm? Back of a weapon with such power as the tourniquet there must be some intelligence. There has been a marked increase in the general and average intelligence of the men generally in the employ of railway companies. Go back in the history of railway surgery twenty-five years; I can remember when a poor man would be run over when the thermometer was 10° below zero and the employes would allow him to lie right there, never think to cover him up. I can look back, and remember where several cases died because of cold. I can say for railroad companies, that a few of these cardinal principles have been quite sufficiently instilled among railroad men to-day, they seem to understand that cold is a very dangerous factor. Let a railroad man get hurt now, and one of the first things they attempt to do is to get him where it is warm. The knowledge of the railroad man of to-day

is extensive enough to know where a man is run over and crushed, and in ninety-nine times out of a hundred ground into the cinders of the roadbed, anything, even the road waste would not add very much to the infection already present, and I doubt very much whether an emergency package in an injury of this magnitude would be of much benefit. Surely, it would do no harm, but I doubt whether it would be of very much benefit.

Now, as to the emergency package on railroads, it has been tried, and I doubt whether it has been adopted by very many. In the last few years a great many roads adopted these emergency packages through the chief surgeon, but all abandoned them. And why? Where do they put the emergency package in the ordinary caboose? No place in particular, it bumps around, and you can imagine the condition of it after bumping around for two or three, or six months. The great trouble is railroad men do not know when accidents are going to happen. They come when they are least expected and at the time they do happen they may be a good ways from the caboose, it may be in the night, and they cannot find the caboose, and when they find the caboose they cannot find the emergency package, and finally locate it on the floor where it has been kicked from one end of the caboose to the other, and is very little if any better than the handkerchief, or road waste. And so it has been found out the emergency package is impracticable. The emergency package is all right, but you cannot keep it all right. Railroad men do not work from any humanitarian view, but for the money there is in it. They are not expecting to get a patent on friendship, but when they are a friend you cannot find a class of people who will do more than they do for one another. As Dr. Brockman has said, the only thing to do is to try to instill general principles into their minds. Now, why cannot railroads have on their time cards these few general principles. Every railroad man carries a time card, and all their work is gov erned by that card. Explicit instructions are on them as to what to do in every emergency, and every once in a while the men are examined on the rules and regulations printed on these cards, and you would be astonished at the voluminousness of them. Now, it would not be diffi cult to have incorporated into these cards and made a part of their study (or curriculum as you might call it), some of these first principles instilling cleanliness, or the adding of heat and warmth when necessary, and the necessity for controlling of hemorrhage by something. I find in a great many instances the men have taken their suspenders to put around an arm or leg, and put a stick in and twisted it. But these cardinal principles, it seems to me, are about all that can be done in that line to-day. The employes are ready to do anything, provided they are instructed what to do, and what not to do.

Dr. Sneve (closing discussion): I have been gratified and instructed by the discussion. I agree with Dr. Brockman that large vessels spurting out blood will cause a person to die in a short time and some one ought to put a tourniquet around the leg and stop the bleeding. While all agree that First Aid instruction on the Northern Pacific or the Union Pacific, for instance, is a good thing it is not necessary in well populated regions. Accidents usually take place where switching is done and in Iowa,