much a necessity to the organism as nutrition itself. But let anyone consider the interminable, constant brain harrowing influences which press in upon the railway service, and he will feel that a master of modern motion is a martyr to modern methods.

This is not confined to the steam railway service alone; indeed in the street railway service of our great cities we are confronted with a tremendous shadow of neural death if you will permit such a license of methephoric expression.

I have often felt in my very heart an active sympathy for the thousand and one irritative influences which wear away the life of the conductor and the motorman like vultures feeding upon the lives of Prometheus bound to the everlasting rock. It is but necessary before a body of such intelligence to bring out these salient facts in a short and formulated manner as we have endeavored to do in this paper.

Now it remains to give the Hamlet of the play, i. e., the remedial agencies necessary to control or even modify the conditions set forth above.

Time would fail us to enter into the full therapeutic indication set forth in our fundamental principles, but there are, thanks to the ingenuity of pharmacal and chemical devotees -certain combinations so constructed as to enter without further digestive action distinctly into the several tissues of the body, supplying the waste without draft upon the normal cellular activity of the organism. I believe, yes, I even know, that these conditions have been met in the preparation called melachol, which not only contains the normal inorganic constituent of the wasting nerve organism, but also by its steady peristaltic action opens the pathway of excrementitious function.

We are in the very vestibule of physiologic temple. There is much yet of glory to be seen behind the veil-behind the veil.

Think of the thousands and tens of thousands of railway servants who are wearing out their lives upon the grindstone of greed! Think, too, of those who as passengers must suffer the constant roll and rattle and rumble of the railway rush in the mighty ongoings of modern commercial life. Well it is a fearful problem. We do believe that the time has come to look this important issue in the face and meet it with the stern facts of science.

As to the organic conditions developed by railway pathology, they are fully met by that almost perfect physiologic combination of nucleins the very essence of physiologic principles-protonuclein, so peculiarly adapted to railway use.

DISCUSSION OF DR. SUMMER'S PAPER.

Dr. W. B. Outten: I expected to have heard the doctor touch upon railway spinal shock, but he has not done so. I want to say that while I appreciate very much what the doctor has said in his paper, if he were to say all those things to that gentleman who handles the lever, who sits on the box, he would turn around to Dr. Summers and say, "What in thunder are you talking about? Do you think I am green?" I have been in the railway service for years, and when I first started I was very eager to find a railway disease. I will give you my word of honor, that no man ever hunted for it more than myself, and I have not found one yet.

In the paper I read last year I gave the results of the study of a hundred and fifty-three thousand cases, and I believe Dr. Gant, who has since written a book on rectal surgery, went over these reports with me. They were compiled from the reports of the Missouri Pacific Hospital Department, and the only disease which could be said to be due to the occupation, was constipation, in consequence of irregularity of living, jolting of cars, etc. I think Dr. Adam Smith was the one who stated that about one-fourth or more of railroad engineers had diabetes. Out of one hundred and fifty-three thousand cases there were only one hundred and three cases of diabetes among these employes. I have searched for railroad kidney, but have never found one in my life that was really ascribable to the occupation of railway employes.

Dr. Cyrus Edson, who claims to cure consumption, wrote an article in which he stated that he had found railroad kidney, shortly after which I wrote 870 odd personal letters to the engineers on the Missouri Pacific system, and from the replies I received, I must unhesitatingly say that none of them had railroad kidney. In the number of years I have been engaged in railway surgery (since 1876), it has been my good fortune to mingle with employes in every position. I have sat with them at the bedside, held communion with them in every direction, where there was noth

ing secret between us, and they were just as free to express themselves on any point as two railroad men can be. Picture to yourself the average man who runs on a railroad train, and you will find that all nature aids him to keep well. There is a continuous change of scene; there is that excitement which is healthful in itself, and when these men are sick we cannot ascribe the basis of their disease to their occupation.

President Murphy: After hearing the remarks of Dr. Outten, I am certainly justified in calling upon Dr. Patrick Henry Hoy to discuss this paper.

Dr. W. S. Hoy: I do not know how I came to be dubbed Patrick Henry Hoy. I do not know whether to blame Dr. Thorn or my friend Dr. Outten for it, but it is certainly a misnomer.

I desire to say one thing in regard to the paper, which was so beautifully and eloquently read for our gratification and pleasure. The speaker was away off in dreamland. I have made a special inquiry among the employes on the C. H. & D. system regarding railway kidney, and I have yet to see the first case in which a railroad man has Bright's disease of the kidney, or any acute disease of this organ as a result of his occupation. While Dr. Summer's language was beautiful, his theory was bad. There is not a railroad man to-day in this country who has any disease incident to the occupation which he follows. If fresh air, change of scene, change of occupation, mean anything, it is certainly for the good of the railway employes' health.

Dr. John Punton: I have listened with a great deal of interest to Dr. Summer's paper, part of which I can agree with, and part of which I cannot. I believe that there is such a thing as occupation neurosis. I am satisfied that there are conditions which dispose to nervous troubles, that are peculiar to men connected with railroads. I refer more especially to telegraph operators and clerks. A great many telegraph operators have writer's cramp, and so also do clerks. I have had occasion to treat quite a number of such cases and some were employes on the Missouri Pacific road, and I think their troubles were largely due to their occupation. Skepticism in regard to these nervous troubles sometimes is a sign of weakness, and I am inclined to think that when we sneer at conditions of

neurasthenia, we are sneering at something which we do not fully understand. I am perfectly willing to take the doctor's idea of this subject, if he will accept his closing sentence, that "we must look this subject squarely in the face and meet it with scientific facts." I am willing to meet him on that ground. I believe that there is such a thing as neurasthenia, and that it can be met with facts of scientific importance. I think, also, that there is not only an honest, but an erroneous side to neurasthenia.

Dr. P. Daugherty: Dr. Outten spoke of constipation as being common to railway , men and I agree with him. I have also found that engineers and firemen suffer from lumbago. It is an affection peculiar to them and to many other trainmen. I find more cases of lumbago, than of any other one disease. I have, therefore, put down lumbago as an affection peculiar to railroad men.

Dr. Emory Lanphear: I beg to call the attention of Dr. Outten and Dr. Hoy to a very recent report upon the condition of the motor nerves. Since the introduction of electricity as a motor force in street transportation, there has developed a peculiar neurasthenic condition in the men who have taken the place of the old drivers upon the slow-going street cars, and it is a nervousness which may very aptly be termed railway neurasthenia, because so far as investigations have gone, the affection is never found in any other occupation. This condition of neurasthenia is characterized by peculiar symptoms, the first noticed being insomnia. The motorman finds that he cannot sleep, and consults the surgeon of the street railroad for some remedy to overcome it. Not only is he affected with steeplessness, but there is often a delicate tremor of the upper extremities. It is accounted for upon the theory of the intense nervous strain put upon the motorman as he oftentimes approaches the thickly populated parts of the city at a tremendous speed, where he is compelled to look upon one side for a time, then upon the other, for pedestrians in front or for obstacles in his way. All of these things taken together making such a strain upon the nervous systhem, that prostration of the nerves is the result, the first symptom being insomnia, and the second a nervous tremor. These cases have come to light within the last few months, and have been described as an intense nervous strain, which is to be met with in men of probably no other occupation. This is completely in the line of railway neurasthenia, the term being applied to them by a neurologist, who has already reported cases.

Railway Surgeon

PUBLISHED EVERY OTHER TUESDAY BY

ways, inviting discussion of the various propositions:

"1. Can passenger coaches of all classes be constructed in such a manner as to secure more satisfactory ventilation, heating, closet accommodation, and cleanliness than now ob

We have just received a reprint of the "Report of the Committee on Car Sanitation," presented at the meeting of the American Pub-. lic Health Association at Buffalo in September last by Dr. Granville P. Conn, and deem its contents to be of sufficient interest for review at this time. Dr. Conn first called attention to the fact that the retrenchment and general economy necessary since the publication of the last report have made it impossible for the railways to make many changes or improvements not absolutely necessary, but he shows that the agitation of the subject has attracted the attention of railway managers and set them thinking of ways and means for the realization of better sanitary arrangements. Many letters have been received by Dr. Conn, as chairman of the committtee, from railway men, indorsing and commending the work and offering suggestions. In March last a circular letter containing the following questions was sent out to the management of different American rail

cost of construction?

"2. Do you have on your road. any person educated in hygiene and sanitation, who can be held responsible for the sanitary condition of passenger coaches, or to whom the corps of car cleaners are held accountable for the strict performance of their duty? And in your opinion is it practical or good policy to have such a person?

"3. Do you believe a car cleaning department, organized under a person fully educated in such work, the same as the general freight or passenger agents should be in their respective bureaus, would increase the efficiency of the system, and with his experience, be able to cooperate with the superintendent of rolling stock, in giving information that might be incorporated into specifications to be observed in the construction of new coaches, thereby giving improved conditions without additional expense?

"4. It may not be practical to reject or set out passenger coaches coming from other roads, that are unclean, untidy, and unwholesome by reason of the filthy condition of closets, floors, etc., yet is it unreasonable to establish a system of sanitary inspection that would place the full responsibility of these conditions where it rightfully belongs, the same as is now done in cases of structural defects in rolling stock?"

A gratifying number of replies were received. The following from the general manager of the Grand Trunk lines is a fair sample: "To the Committee on Car Sanitation of the American Public Health Association:

"I have your favor of March 25, with pamphlet upon the subject of car sanitation, and, replying to the inquiries you make in the order they are named, will state:

1. The present system of ventilation obtained by means of sashes in the roof of the car, and by the opening of the doors and windows, fairly meets the requirements, having regard to the expense. I am afraid that the term 'ventilation' is too often held to cover

the question of car temperature. There is no serious difficulty in properly ventilating a car and keeping it at an even temperature, if ice is used in the summer and warm air in the winter, but arrangements would have to be made to prevent the passengers from interfering with the inlets and outlets. Anyone who travels must notice what different views are held by the passengers as to what constitutes

good ventilation, and the problem to be solved is how to secure this in an inexpensive manner and without the admixture of dust. The problem can be solved, no doubt, with a not inconsiderable addition to the first cost of the car and with the cost of the necessary ice, and with intelligent manipulation.

"2. The employment of a person educated in hygiene and sanitation to see that cars are properly cleaned, may be considered a forward step Such duties are now performed by the foreman of the car department.

"3 I doubt if a car-cleaning department, organized as you suggest, would increase the efficiency of this system, while it would undoubtedly add quite largely to the expense.

"4. Conductors and car examiners report cars which are wanting in cleanliness, and upon their reports necessary action is taken to correct the trouble complained of.

"I may say that the desire on the part of all railway companies to in every way cater to the public welfare and thereby attract travel to their respective lines, will, even in the absence of specific laws on these matters, insure all the care and attention possible, so far as the sanitary condition of the equipment is concerned. "Yours truly, CHARLES M. HAYS." Commenting, Dr. Conn says:

"It should be a matter of congratulation to the public, to know that the railway managers of such through lines as the Grand Trunk Railway of Canada recognize the fact that to cater to the public welfare is to attract travel to their respective routes. Mr. Hays says that 'the absence of specific laws on these matters' does not matter, as everything will be done to insure care and all possible attention. This is a public spirit that should be emulated all over the country, for everything that pertains to the public health is for the public good, and it was long since demonstrated that 'public health is public wealth.'"

The report calls attention to the work of The Railway Surgeon along these lines, and quotes the circular letter sent out by the editor early this year and our summary of the answers received. An excellent paper by Dr. Domingo Orvananos, of the Superior Board of Health of Mexico, on the cleaning of passenger cars is published in full. He advocates extreme simplicity in the interior construction and furnishing of railway coaches, the doing away with all kinds of hangers and even carpets, and the frequent efficient disinfection of everything in the cars.

And this we believe to be the keynote of the whole subject. The interior of a car, it seems to us, could be made as attractive as the mod

ern coach and as truly comfortable, and yet. with smooth, impermeable walls and floor which could be thoroughly washed and disinfected if necessary. If the public demands upholstered seats they can at least be completely covered with smooth, washable covers, which should be changed daily. If a mattress can not be frequently renewed or cleansed it can certainly be covered with a separable cover which can be washed daily with the sheets and pillowslips, and we must insist that the blankets be washed as frequently as is done in our own homes. In the case of transportation of invalids additional precaution could easily be taken, and everything coming in contact with the patient disinfected at the end of the journey.

Antiseptic Uses of Formalin.

Dr. T. S. K. Morton stated that last spring and summer he had used formalin considerably, but found it to be too great an irritant to be used as a routine method. Bacteriologists are almost unanimous in praise of its germ-destroying qualities. It is, perhaps, the most powerful antiseptic we can employ. He had found that great dilution was necessary for injecting into cavities or putting upon the skin. It cuts the fingers of the surgeon in even weak solutions.

It seemed to act as a very powerful disinfectant upon ulcers or foul wounds. When it was sprayed upon such processes they would at once lose odor. The pain following application was sometimes severe while it lasted, and it would persist for hours occasionally. On these grounds he had been very reluctantly compelled to largely abandon the use of the agent.

The commercial product is formic aldehyde gas dissolved in water to the extent of 40 per cent. He found it very efficient in destroying epithelial growths, such as warts and superficial epitheliomata.

In regard to the use of formalin in the preparation of catgut, Dr. Frank Hartley, of New York, has abandoned it, after a careful study, because he found that formalin catgut showed a reduction in strength, as given by an accurate testing machine, of 50 per

cent.

Dr. Hunter Robb has recently spoken very highly of formalin-catgut, and very ingeniously suggests that all prepared catgut be stored in culture media until required for use. If used out of culture medium showing no growth you are absolutely sure of the catgut being free from bacteria and spores.-Annals of Surgery.

Notes of Societies.

New York State Association of Railway Surgeons..

The sixth annual meeting of the New York State Association of Railway Surgeons will be held in the Academy of Medicine, 17 West Forty-third street, New York City, Tuesday, November 17, 1896.

PROGRAM:

1. "Modern Methods in the Treatment of Fractures," Dr. R. H. Cowan, Radford, Va.

2. "How Can We Best Secure Immobilization in Compound Fractures at or Near Articular Processes?" Dr. Z. J. Lusk, Warsaw.

3. "Immobilization and the Treatment of Fractures at the Elbow-Joint," Dr. J. H. Glass, Utica.

4. An address, "Injuries to the Head," Dr. Roswell Park, Buffalo.

5. "Relief and Hospital Department," Dr. Frank H. Caldwell, Waycross, Ga.

6. President's address, Dr. C. S. Parkhill, Hornellsville.

7. "Traumatic Neurasthenia," Dr. J. E. Walker, Hornellsville.

8. "Cases of Apoplexy Following Some Time After Accidents," Dr. Wiliam Browning, Brooklyn.

9. "Cranial Injuries," Dr. W. A. Ward, Conneaut, Ohio.

10. "Distinctive Features of Railway Surgery," Dr. R. S. Harnden, Waverly.

II. "Granulation Surfaces," Dr. John Van Duyn, Syracuse.

12. "Chloroform Anæsthesia," Dr. Webb J. Kelly, Galion, Ohio.

13. "Injuries to the Eyeball," Dr. Samuel Mitchell, Hornellsville.

14. "Acute Infective Thecitis," Dr. A. Llewellyn Hall, Fairhaven, N. Y.

15. "Compound Fracture of the Skull, with Injury to the Brain Substance," with report of cases, Dr. J. G. Kelly, Hornellsville.

Report on Transportation for the Second Pan American Medical Congress.

The following letter has been received by the editor the Railway Surgeon for publication:

Mr. Dear Doctor:-I have the pleasure of announcing the following transportation rates to the delegates, their families and friends for the meeting of the second Pan American Medical Congress, to be held in the City of Mexico, Mexico, on November 16 to 19 inclusive, 1896:

The New England roads have made no reduction at all in rates, and the trunk lines have made no general reduction, but have agreed to special rates from the points mentioned in

their territory, viz.: From New York City to City of Mexico and return, $78.50; from Philadelphia and return, $76; from Baltimore and return, $73.50; from Washington and return, $71.50.

Those attending the congress from the New England states and the territory of the trunk lines east of Pittsburg, Erie and Buffalo will purchase regular local tickets to nearest point mentioned in reductions, either New York City, Philadelphia, Baltimore or Washington, and at either of these cities purchase the through ticket at the reduced rates to Mexico and return as above stated.

Should the delegates desire to enter Mexico by one gateway, say Eagle Pass, and return via another gateway, either Laredo or El Paso, an additional charge of $5.75 total will secure such privilege.

Pullman berths from New York, Philadelphia, Baltimore or Washington to City of Mexico will cost $23 each way on regular trains over any line.

Delegates residing in Central Traffic territory embracing the territory from Buffalo, Pittsburg and Parkersburg, W. Va., in the East, to Chicago and St. Louis in the West, will be accorded a round trip ticket to City of Mexico over any of the lines on the payment of one first-class fare.

Delegates residing in the Western Traffic territory will be accorded the round trip ticket to City of Mexico for one fare over the following roads only: Missouri Pacific, Illinois Central, Wabash, Chicago & Alton, Atchison, Topeka & Santa Fe, Chicago, Rock Island & Pacific, Chicago Great Western, and Burlington, Cedar Rapids and Northern railway.

Delegates residing in Southern Pacific territory will be accorded the one-fare rate to the City of Mexico and return. The three Mexican lines have accorded the round trip for one first-class fare.

OCEAN ROUTE.

The fare over the Ward Line for the round trip from New York City to City of Mexico, via Tampico, has been reduced, and for this occasion will be $78, including meals and stateroom. The fare one way, going or returning, including meals and berth, will be $45. The trip either way is made in ten days. Steamer will leave New York City on November 4, tickets good until Dec. 31, 1896.

Those desiring to go by boat and return by rail, via El Paso, will pay $111.75. The expenses for sleeping car for one night, and meals between Tampico and City of Mexico, will amount to about $4 in American money. Returning the sleeping car rate per berth is $9 Mexican silver, or $4.50 American money, between City of Mexico and El Paso, and $15 American money El Paso to New York, or