My form of examination is as follows: The applicant presents himself with a card from the superintendent of the division to which he belongs requesting an examination.

I test the distant vision by Snellen's test, and new employes must have normal vision. If the examination of old employes shows one eye normal and the other one-half normal, a certificate is issued.

I then use Holmgren's method for the color test, and if the applicant is able to pass the same the examination is practically complete.

Thompson's method, varying slightly from this, I use as a second test, and on finding all correct I dismiss the applicant and sign a certificate, sending a report to the superintendent, who sends the same to our chief, Dr. G. K. Johnson, who indorses the report.

If an applicant fails in this and then cannot realize his defect, I examine him by the following device, arranged at my office: I have a caboose end built in a recess for that purpose. I have at the top and at each side and on the platform a lantern; these are the same as those in use on the rear ends of trains on the various roads. Colored glass is placed in them, behind which are electric lights of the same luminosity. The candidate is placed 30 feet away and asked to name the light as flashed. In every instance of color blindness errors in distinguishing the right colors are shown as with Holmgren's test.

This form of examination is done with a view to prove the correctness of Holmgren's test, and also to convince the skeptic that error does exist and its proof is palpable.

my duty to examine the men on the C., H. & D. system as far down as Ohio, and having examined a large number of sectionmen and trainmen, I found a number of persons in the employ of the company who were old and trusted employes, who had been on the road for years, and had never had an accident befall them. In two instances which I remember at this time, when Thomson's test was presented, the men had no means of knowing red from yellow, or blue from green. If I put out a red color they would be apt to call it blue or green, and they were just as apt to call it rose as any other color. After having failed on Thomson's test with skeins of yarn, I found that these men could go into the yard at night and designate promptly the lantern signals. While on the subject of color blindness, it has been said in the paper that some trainmen have difficulty in hearing. This is true. I have known men, standing the eye test, who could scarcely hear a watch tick at twelve inches, six inches, or even four inches, and who when the engine was blowing could hear an ordinary conversation. There seems to be some circumstance connected with the life of the engineer on a train which enables him to perceive by sound. What do we mean by color blindness? We mean inability of the individual to differentiate certain colors presented to him, and which are used on railroad trains for signals. We all know that if we were traveling on a train, we would feel more secure did we realize the fact that the trainmen, the sectionmen and stationmen, had an accurate idea and conception of the various colors presented, especially at night. Strange as it may seem, some of the old and trusted employes of the railroad companies of this country have run trains for many years without having met with any accident or without having been the cause of loss of life to the traveling public. I say these things are strange, and we have great hesitancy in reporting to the company a man who cannot stand the required test. As surgeon of the C., H. & D. system I think there is a great deal in connection with color blindness that we ought to overlook. A great many men cannot differentiate between colors. While they may pick out the fundamental color they cannot select the shades of the color.

I have interviewed a number of engineers on our road concerning the difference in seeing between the electric headlight and the old-time lightning bug headlight, and they tell me while behind the light, going away they can see a long distance before them, but at the approach of the train with the electric headlight, they are not able under any circumstances to regulate or calculate the distance of the engine with the electric light away from them. They cannot tell whether they are 600 or 800 yards distant. I have made I have made a special inquiry about this matter and have found that the majority of engineers do not like the present system of electric headlights.

Dr. C. D. Wescott, Chicago: I quite approve of nearly everything that Dr. Welsh has said, particularly the statement that the examinations should be conducted by an ophthalmologist rather than by a foreman or su-. perintendent. I also believe that examinations for vision and color blindness should be repeated at least as often as once in five years. We all know that vision fails and that certain forms of nervous disease may bring on changes in the color sense.

It is true that some railroad men may fail with the Holmgren or other office tests, but may succeed in differentiating perfectly on the tracks, or when examined by lanterns in the way that Dr. Welsh has suggested. I therefore believe that these tests should always be made as practical as possible; be made to embody as closely as can be the actual experience of men on the train and on the track; in other words, no matter how carefully and thoroughly the Holmgren or Thomson test may be carried out, the test with the colored lanterns should be added and the circumstances should imitate as closely as possible the conditions on the road.

It is very perplexing to know what to do about cases of partial color blindness. I am partially color blind myself and can appreciate very well the condition of trainmen who can under ordinary circumstances recognize without difficulty the different lights, but who are at a great loss in a foggy or smoky atmosphere. In driving along a country road, a person with perfect color sense will see red cherries on a tree long before an individual like myself. My own wife has poorer vision for form than I have, but her color perception is perfect.

She can recognize cherries on a tree at twice the distance at which I can perceive them. In a clear atmosphere I can distinguish colored lights on the track very well, but in a smoky or foggy atmosphere I am in great doubt. These are the puzzling cases, but as only four per cent. of the men we examine are defective in color sense, we work no great hardship if we reject them all. The argument is often raised, that we should not reject a man with defective color sense who has done good service for the road which employs him for twenty or twenty-five years, and perhaps has never had an accident during all that time. It is considered a hardship to dismiss such a man. Nevertheless, we should not have men with defective color sense in the train service.

At our last meeting you will remember that Dr. Williams exhibited an apparatus for carrying out color tests with colored lights. It does not imitate as closely the conditions on the track as the method of Dr. Welsh, but it is capable of more modification, and a greater number of different colored glasses can be brought in front of the light than by any other method with which I am familiar. If we could adopt a standard all over the country for these examinations it would be very desirable. It is proper for this association. to work in that direction.

Dr. Hoy: Why is it the percentage of color blind females is much less than males?

Dr. Wescott: Because it is a matter largely of education. As a rule, the females are more familiar with colors and work with them more than do men, and it is a matter of education, and perhaps of heredity.

Dr. Hoy: Do you believe the eye can be educated to overcome color blindness?

.Dr. Wescott: Possibly, through certain channels. I believe many cases of partial color blindness can be overcome or improved by education. In some cases a defective color sense seems to be psychic rather than organic. Dr. H. M. Bannister of Chicago has written. an interesting paper on "Color Blindness as a Psychic Affection." It would be interesting to every railway surgeon, I am sure.

Dr. W. B. Outten, St. Louis: I will grant that the oculists are absolutely correct from a scientific point of view with regard to color sense, and were I an oculist I should doubtless hold the same views. However, I main

tain that in the running of a locomotive, that so far as the engineer is concerned, there is not an element with which he is surrounded and connected but what he is thoroughly educated and trained. Every nerve he possesses is well trained. There is not an engineer who runs an engine but what has his method of running it, and his plan is carried out year after year irrespective of his color sense. He is thoroughly familiar with the roadbed, the curves, the up and down grades of the track over which he runs. To illustrate what Dr. Hoy said, that in order to test the hearing a watch should be held eight feet from the ear. Look at the utter absurdity of this proposition. The tick of watches is entirely different. If it were possible to have a uniform tick made according to a given rule, we would have a standard to go by. Irrespective of that, amid the roar of steam and rattle of the train the engineer has an ear which is thoroughly educated as regards noises, and he is more competent to hear the click of a defective piece of machinery than any of you or I. The senses of the engineer are acute and active. He has to watch a number of things in front of his engine. He has got to hear and see. I can show you men who cannot tell red from green, yet they are capable, careful, cautious engineers. Take a train going at the rate of sixty miles an hour and the engineer may not be able to tell whether he sees a red light or not, but we consider the brains of the individual. It seems absolutely cruel to dismiss a man who is thoroughly competent in every way except in this one particular, that he has defective color sense. The other senses of engineers are educated to the highest point. Defective color sense alone should not condemn a man and result in his rejection as an engineer, after he has done good and efficient work for the road that employed him.

Dr. Welsh (closing): I am glad my paper has elicited some discussion. Dr. Hoy has spoken in regard to the matter of testing the hearing. I did not mention this in my paper, having left it out entirely. We find a great many engineers who have very acute hearing, while others are defective in this regard. Sounds and noises which are mild and pleasing to engineers would be painful to those possessing normal hearing.

With regard to color blindness, the applicant is not required to make mention of the color presented. No name is asked of him of the color shown. For instance, a lot of yarns are thrown on a white piece of muslin, in a good light; one test color is selected, and the applicant is asked to pick out colors lighter or darker, or any shade of that color. The question of naming the color does not enter into the examination at all. Difficulty will arise in the selection of the colors.

A point referred to by Dr. Outten is well illustrated in two cases in which examinations were made by myself, namely, that dependence is placed upon the engineer, or the fireman, and vice versa. To illustrate: One of the younger engineers in age, who has been running a locomotive for fifteen or sixteen years on the Chicago & West Michigan Railroad, and considered one of the best men on the road, and is given fast trains and specials to run, and carries the superintendents and general managers from point to point, one night in going into a station mistook the color and ran into an open switch. A red light was turned on him, and just as they were going around a curve the fireman was doing something on the inside of the cab and did not perceive the color. This was not known, and when an examination was made by the superintendent the color was given as white. The claim was made that in passing over the switch it jumped and threw them off the track. This engineer was sent up for examination along with other engineers and firemen, and when a regular examination was made it was found that he was color blind. He could not tell red, could not tell green, he was red-green blind. His fireman had defective vision, that is, vision was equivalent to about 1-10 normal vision. I made a report to the superintendent of the division and he was laid off with the request to go home and study all colors and come back for re-examination. This was done, and at the end of a month he failed in this examination. He returned in six weeks to two months again and failed again. I have examined him at various times since then until the present, covering now a period of some three years, and at each examination he makes the same error. It has since been learned by the officials and by a statement made by the fireman and engineer, that the fireman

depended on the engineer for vision, and the engineer upon the fireman for color.

Another case in point. An engineer and firemen were sent for examination, and it was found that the fireman was color blind, while the engineer had only two-sevenths vision. This I knew prior to the examination because I had examined him about six or eight years previous to the time he was sent up for examination. After the examination was completed and the report sent to the superintendent of the division, and the engineer receiving notice that he would not be employed, it was learned that he depended upon the fireman for color sense, and the fireman on him for vision.

In regard to engineers and firemen making mistakes at your office and not on the road. If you change the surroundings, put them on different roads, they cannot locate the switches. They will make the same error, or else approach the switches with undue caution so as to be able to stop in case of emergency, and it is a notable fact that this plan is tried among engineers who are old in the service. On approaching the station it was noticed how extremely careful they were in entering the station to see that everything was correct, and also in approaching switchlights.

Regarding the use of the electric light, referred to by Dr. Hoy, it is much easier at the office than other lights. On the Grand Rapids and Chicago & West Michigan Road lanterns are swung in front of the applicant to decide what color is presented to him. The intensity of the flame is always the same, and this makes quite a difference. If there is no defect in vision there is no mistake in selecting the color. If the applicant is visually defective it is simply guesswork.

An Unusual Termination to a Malpractice Suit.

Dr. W. O. Henry of Omaha has had a somewhat novel experience with the courts. He sued a patient for the amount of his bill and was in turn sued by the man for malpractice, damages being set at $8,000. Not only was the Doctor victorious in disproving malpractice, but he convinced the plaintiff and his attorney of the justice of his cause, and the former went out and borrowed $345 with which to pay what he owed for medical services, to save which he had instituted the malpractice suit.

CLINICAL REPORTS.

Kansas City Hospital, Missouri Pacific Railway Hospital Department.

OSTEOMYELITIS.

A. B. W., an agent for the Missouri Pacific Railway, aged 24, and maimed, entered the hospital December 9, 1895, with an osteomyelitis, which was the result of an injury received eleven years ago. The right tibia was very much enlarged anteriorly, and a sinus extended into the medullary canal to the depth of three inches. The anterior surface of the shaft of the tibia corresponded to the swollen portion some three inches in extent. The medullary canal was thoroughly curretted and all necrotic and inflammatory tissue removed. The operation was performed by Dr. Hamel. Good recovery.

COMPLICATIONS FOLLOWING AMPUTATION.

W. B. M., single, clerk, Missouri Pacific railway, aged 31, was run over while attempting to get on a moving train July 20, 1895. The left leg was crushed at the junction of lower and middle thirds. It was amputated five inches below the knee, cutting through apparently healthy tissue. The flaps and muscles sloughed after twenty-four hours, followed by cellulitis of the entire leg and thigh, complicated by a sapræmic condition. Secondary amputation was made August 20, 1895, and the bone sawed through the tubercle of the tibia. The stump healed kindly and union was complete in three weeks. Several weeks afterward a very large and painful neuroma was developed in the stump, and this, with the head of the fibula, which was left after the secondary amputation, were removed. The patient is well. These operations were performed by Dr. G. F. Hamel.

AN ISCHIATIC BURSITIS.

T. McH., engineer Missouri Pacific Railway, entered the hospital last March, presumably with an ischio-rectal abscess. It was opened, but did not do well. The trouble began with a swelling to the inner side of the right tuber-ischii. The original trouble was undoubtedly an ischiatic bursitis of several months' standing before he entered the hospital, which afterward suppurated. This was complicated by a severe diarrhoea, which lasted

several weeks. Examinations revealed sinuses extending in all directions, passing around the tuber ischii down between the flexor muscles of the thigh to within three inches of the knee joint, upward following the course of the sciatic nerve and then upward and inward along the outer side of the ilium as far as the sacro-iliac articulation. The patient was put under the influence of chloroform anæsthesia and all the sinuses were laid open, extending from the lower opening in the thigh to the inner side of the tuber-ischii and upward and outward for two inches, then upward and inward on the dorsum of the ilium to the sacro-iliac articulation. Further examination revealed necrosis of the tuberosity of the ischium, and a piece of necrosed bone as large as the first joint of the thumb was removed from the inner side of the tuberosity. In laying the sinus open a part of the gluteus maximus and biceps muscles were cut through, when another sinus was found extending up under the gluteus maxiums muscle to the outer side of the tuberosity of the ischium. The wound was thoroughly curretted and packed with gauze. The operation was performed by Dr. Geo. F. Hamel and the patient recovered completely.

FRACTURE OF THE NINTH AND TENTH DORSAL

VERTEBRÆ.

F. S., married, aged 26, coal heaver for the Missouri Pacific Railway, was injured at Sedalia by falling from a coal chute. He was admitted to the Kansas City hospital July 24, 1896, with complete paralysis of sensation and motion from twelfth rib down. There was an absence of all reflexes except the cremasteric. An examination revealed fracture of the ninth and tenth dorsal vertebræ. In the absence of Dr. King, consulting surgeons Smiley, Fulton and Thompson were called in and confirmed the diagnosis. The patient was put under the influence of chloroform and an incision made over the spine, extending from the ninth to the twelfth dorsal vertebræ. The muscles were cut away. Further examination revealed comminuted fractures of the spine and laminæ of the ninth and tenth dorsal vertebræ, with dislocation forward of the ninth vertebra. The ninth and tenth ribs were fractured and the parietal pleura was ruptured. There was complete disorganization of the cord from pressure. On July 29 patient had a chill, followed by a tem

H. O. B., aged 36, single, painter for the Missouri Pacific Railway, fell from a ladder, sustaining a Colles' fracture of the left radius and concussion of the spinal cord, followed by paraplegia, and further complicated by multiple neuritis and cystitis from using the catheter. A vesical calculus formed. Perineal cystotomy was performed and a calculus as large as a filbert removed. A doubt still remains whether this stone was previously formed in the bladder or whether it could have formed within a month. Dr. Hamel operated. The patient recovered.

RECURRENT OMENTAL HERNIA.

John L., married, aged 34, locomotive engineer. Diagnosis: Recurrent right, oblique omental hernia. The patient was operated upon about one and a half years ago, when a McBurney's operation was made. The hernia recurred within a year after the operation. He was again operated upon December 28, 1895. It was intended that a Bassini's operation should be made, but after making an incision it was found impossible to do so on account of the abnormal condition of the parts and extensive adhesions of the sac and entire contents. About eight ounces of omentum was removed, as it was impossible to return it on account of adhesions. The operation was performed by Dr. Hamel and was followed by recovery.

AMPUTATION-OPEN FLAP METHOD.

A. B. A., switchman for the Missouri Pacific Railway, had his left leg crushed at the junction of the middle and lower thirds. The leg was amputated four inches below the knee on September 21, 1895, and the stump was treated by the open method, on account of the unhealthy appearance of flaps and muscular tissue; about one inch of both flaps and the muscular tissue on the fibular side of the stump, sloughed. After the necrosed tissue came away, the remaining portion of the fibula was removed and the flaps sewed together.

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