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"How to Cure Rheumatism," by Elmer Lee, A. M., M. D., Ph. B. Reprinted from The Journal of the American Medical Association, July 25, 1896.
"The History of the Discovery of Anæsthesia," by Burnside Foster, M. D. Reprinted from the Northwestern Lancet, 1896.
"A Series of Articles on Speech Defects as Localizing Symptoms, from a Study of Six Cases of Aphasia," by J. T. Eskridge, M. D. From the Medical News, June 6 to September 19, 1896.
"Electro-Diagnosis and Electro-Therapeutics Simplified," by Hugh T. Patrick, M. D. Reprinted from Medicine, November, 1896.
The Marine Hospital Service.
There will be held in Washington, D. C., on February 3, 1897, a competitive examination of candidates for appointment to the position of assistant surgeon in the United States Marine Hospital Service. Candidates are required to be not less than twenty-one years of age, and no appointment is made of any candidate over thirty years of age. They must be graduates of a reputable medical college and furnish testimonials as to character.
Successful candidates, having made the required grade, are appointed in order of merit as vacancies arise during the succeeding year. A successful candidate, when recommended for appointment, is commissioned by the President of the United States as an assistant surgeon. After four years of service and a second examination he is entitled to promotion to the grade of passed assistant surgeon, and to the rank of surgeon, and after a third examination, according to priority, on the occurrence of vacancies in that grade.
The salary of an assistant surgeon is $1,600 per annum, together with furnished quarters, light and fuel; that of a passed assistant surgeon, $1,800 per annum, and that of a surgeon, $2,500 per annum. In addition to these salaries, after five years' service, an additional compensation of ten per cent of the annual salary for each five years of service is allowed medical officers above the rank of assistant surgeon, the maximum rate, however, not to exceed forty per cent.
When an officer is on duty at a station where there are no quarters furnished by the government, commutation of quarters is allowed at the rate of $30 a month for an assistant surgeon, $40 for a passed assistant surgeon, and $50 for a surgeon. The successful candidates, after receiving appointments, are usually ordered to one of the larger stations for training in their duties.
Full information may be obtained by addressing the Surgeon-General of the Marine Hospital Service, Washington, D. C.
At a recent meeting of the New York State Medical Society Dr. Joseph D. Bryant of New York County, read a paper on this subject. He stated that, according to the military statistics of the late war, of 287 amputations of the leg examined five months after the operation, in twelve per cent the stumps were still unhealed, and in fourteen per cent they were imperfect. Of 132 amputations of the thigh, according to the same authority, there were 21 unhealed and 21 with imperfect stumps at the end of the same period. So far as he had been able to ascertain from makers of artificial limbs. and from a study of the subject, the three main requisites in securing a good and useful stump were: (1) Such a length of flap that undue traction would not be made on the stump; (2) a movable cicatrix, and (3) a periosteal covering for the divided ends of the bone. The first was the most important, because, if it was attended to, the evils of the others were reduced to a minimum. Dr. Bryant then described the method which he had found satisfactory in dealing with an irritable stump in the lower third of the leg. It was, briefly, as follows: A circular flap was made in the lower third of the leg, of a length a little greater than one-fourth the circumference of the limb at the point of division of the bone. This flap was reflected upward for about half an inch, and then a transverse incision was made across the subcutaneous surface of the tibia, at the line of reflection of the flap, down through the periosteum. The periosteum was also divided by an incision in the log axis of tibia. The periosteum was then pushed up instead of being dissected up with the flap in front. In this way a portion of flap corresponding to the subcutaneous portion of the tibia was lined with periosteum, and this fell over the end of the bone when the flaps were coaptated. The tibia was divided transversely on a line with the periosteal reflection, and the fibula a quarter of an inch higher up. The flaps were coaptated obliquely on a line with the subcutaneous surface of the tibia. It was important, Dr. Bryant said, that the periosteal flap should remain connected with the superimposed tissue, otherwise it would slough away or become absorbed.
Dr. Marcy said that one very common cause of irritable stump-the presence of a neuroma -could be largely avoided by covering over the nerve with periosteum. Where the various layers of tissue were closed by separate rows of sutures, it would usually be found that the stumps were more serviceable.
EXTRACTS AND ABSTRACTS:
Laminectomy for Fracture of the Tenth and Dislocation of the Eleventh Dorsal Vertebræ-By CLIFF LINDSEY, M. D...
Foreign Bodies in the Male Urethra-By HARRY C. HAYS, M. D...
A Case of Anterior Dislocation of the Head of the Radius-By G. W. Booт, M. D. 352 Penis Divided by Silk Ligature By JAMES C. KENNEDY, M. D..
The Railway Hospital. Concerning Vacations. Semi-Centennial of the American Medical Association.....
Median Calcanean Incision..
Conservative Surgery in the Treatment of
The Alvarenga Prize of the College of
Massage and Movements in the Treatment of Fractures....
The Semi-Centennial of the Discovery of
On Fractures of the Femur Caused by
359 Use of Large Non-Pediculated Flaps for Plastic Purposes..
NOTICES AND REVIEWS
359 360 360
Officers of the N. A. R. S., 1896-7. President.. .F. J. LUTZ, St. Louis, Mo. First Vice-President. W. R. HAMILTON. Pittsburgh. Pa. Second Vice President....J. H. LETCHER. Henderson, Ky. Third Vice-President......JOHN L. EDDY, Olean, N. Y. Fourth Vice-President....J. A. HUTCHINSON. Montreal, Canada Fifth Vice-President.. .A. C. WEDGE, Albert Lea, Minn. Sixth Vice-President. RHETT GOODE, Mobile, Ala. Seventh Vice-President...E. W. LEE, Omaha, Neb. Secretary.. C. D. WESCOTT, Chicago, Ill. Treasurer.. ..E. R. LEWIS, Kansas City, Mo. Executive Committee:-A. I. BOUFFLEUR, Chicago, Ill., Chair
J.N.JACKSON, Kansas City, Mo.; JAS. A. DUNCAN, Toledo, O.; J. B. MURPHY, Chicago, Ill.; S. S. THORNE, Toledo. O.; W. D. MIDDLETON, Davenport, Ia.; A. J. BARR, McKees Rocks, Pa.
SOME OF THE INEFFICIENCIES OF THE METHODS THAT ARE ORDINARILY EMPLOYED BY RAILWAY SURGEONS FOR THE DETECTION OF SUBNORMAL COLOR-PERCEPTION
BY CHARLES A. OLIVER, A. M., M. D., Attending Surgeon to the Wills Eye Hospital; Ophthalmic Sur geon to the Philadelphia Hospital; Ophthalmic Surgeon to the Baltimore & Ohio Railway Company, etc.
As illustrative of the first inefficiency, as long ago as 1855, George Wilson of Scotland, one of the first medical men and scientists to practically study the relationship existing between imperfect color-vision and railway travel, and to actually put into use the best methods of detecting the imperfection, found as the result of numerous examples and experiments, that not only may color be recognized correctly at short distances and not distinguished at longer ones, where such colors are plainly discernible to the normal-sighted, but that the sensitiveness to the colors while being gazed at, becomes more quickly lost as they are removed from the eye of the "color-blind" than when they are removed from the unimpaired visual organ.
To these findings he gave the somewhat graphic yet imperfect term "chromic myopia" or short-sightedness to color, which he said that as far as he was aware, "has not hitherto been generally recognized."
Established as one of the necessities to his proposed plans of testing railway employes for imperfect color-perception, it has in most instances been set aside by the sweeping yet ridiculous assertion of inconvenience, impracticality, chance of imperfection of examina
1 Paper read before the June, 1896, meeting of the Association of the Baltimore & Ohio Railway Surgeons.
tion, untrustworthiness, etc.; assertions that will apply much more forcibly to the methods that are now so universally used-loose woolselection at one or two meters' distance.
Here, instead of the test being made at what the present writer has designated as the distances that are requisite for future safety, they are performed at so close a range to the candidate that the results never can be depended upon as of any practical value for the safety of life and property when such eyes are engaged in actual service upon rapidly moving trains that follow one another in quick succession. That any previous test should be efficient when the visual organs are placed under such circumstance it is requisite that it should be made when they are situated under similar conditions and while the eyes are placed in the same positions as they would be when it becomes necessary that they should be the sole means of exercising prompt action in the avoidance of a threatening accident or imminent calamity.
One or two meters' distance away from the point which determines the presence or the absence of a catastrophe is, as all practical railway men know, entirely too close for the avoidance of unfortunate results during subsequent impending danger. A laden engine moving with the rapidity of 20 to 25 meters each second, would have been propelled into destruction long before any engineer could check its speed. In other words, the recognition of the signal must be determined at a safe point; it must be made at a sufficient distance to properly control the moving mass. To do this the visual organ which has almost sole charge of this function must necessarily be able to differentiate color when it is placed at a safe distance; it must have been previously tested to do it at that distance; and the testing must have been done when the eyes were placed under the same conditions and under similar circumstances as when they are employed during actual work.
In the acquired color defects produced by the introduction of toxic agents into the system, such as tobacco, and which appear in the part of the field of vision that is used when any object is gazed at, the testing with large massings of color placed at short distances from the eye as in the ordinary wool-tests, becomes useless; here another worse than inefficiency
comes into play. As the central blind or dimmed area in the field of vision does not always include the whole surface of any of the skeins of wool, the candidates may be passed, thus allowing this most dangerous class of subjects to be placed in service where the subject cannot differentiate the color of signal boards and lights or even distinguish them, as in one instance seen by the writer, where he found a case of tobacco amblyopia actually at work upon an immense railway-system after having successfully passed the near-wool test.
At about the same time that Wilson applied his findings to color-testing among railway employes, Lees of the Edinburgh, Perth and Dundee Railway pointed out another inefficiency. He stated that it was well known that the different degrees of vividity of equal areas of red and white illumination (in fact, of any color) produced alteration in impressions as regarding their relative distances from one another. Based upon this, he asserted that "a red light seen from a distance seems much further than a colorless light side by side with it, the eye assigning a less proximity to the less luminous lamp, in conformity with its experience of the different apparent brightness of lights of the same color and luminosity placed
at different distances from it."
To remedy this in railway color-testing, both the areas of reflected and transmitted colormaterial employed should be graded in size and intensity of tone into proportionate amounts, thus making every color used in the tests of the same distance-value.' That they are not is too well known; that they should be is an absolute certainty.
A third inefficiency in color-testing of this class of subjects is where there is the want of consideration of the situation in which the testing is done.
The examination should be conducted in
1 This, which is just as true, though somewhat less noticeable by diffuse daylight, where the colors as a rule appear darker, is markedly seen when the color hues are strengthened in brightness by being projected against the dark background of night.
These facts are well understood by painters and colorists, who make use of them in their disposition of strongly and weakly reflecting color-areas upon flat surfaces in order to give effects of perspective and so-called warm and cold tone-contrasts.
The application of the rule of simultaneous contrasts to railway work may often be aggravated or even absolutely perverted when new color impressions produced by subjective after-color, as for example as commented upon in the case of a serious collision which occurred many years ago upon one of the Irish railways, in which it is stated that an engineer or stoker might, after gazing into the interior of a furnace box for a few moments' time, see all the color-signals of a greenish tinge.
This rule is equally true for the gradation of the ordinary color-signals used, not only in railway, but more particularly in Inarine service where the danger is very great, especially in well filled and fog-laden harbors.
places where the visual organs are to be employed and under the same circumstances in which they will be placed during actual work. The test should be a practical one. By this means the test-color selection in reality becomes the same as that which later is practically and almost constantly given to the visual organ. The loose-color selection must be removed to a safe distance from the candidate and the test must be placed in the actual line of the railway trackage.
Anyone knowing empirically, if not scientifically, that colors, especially red, green and blue, which are so much used in railway signaling, undergo such diverse modification of hue when seen through varying degrees of solar luminosity, can, if he be conversant with the ordinary methods of color-testing upon many of the railways, in a moment realize another source of inefficiency in the fests as usually applied.
Again, the condition of the intervening atmosphere and the dominant color of the reflecting surface near which the test is made (as for instance the green of a hillside, the gray and the white of a mountain top, the blue of an ocean surface), both play important rôles in the question as to the value of the test; but as a rule they are never considered.
The character of the illuminant itself' is of the greatest importance, and yet how seldom, until recently, in a measure in England, has it been considered. For instance, when diffuse daylight in this latitude and climate is bluish; the zirconia or metallic oxide mantel of the Welsbach light, made incandescent by the admixture of air and ordinary illuminating gas, as in the commonly employed Bunsen burner, generally gives a greenish or nearly white tint; oils, illuminating gas and the varying shapes of carbon loops made incandescent by electrical current all emit varying degrees of yellow rays; and lastly, when arcs of electricity, especially when the current is extremely rapid and strong, may even appear purplish; is it any wonder that under such
The examples: a light red becoming purplish in diminished illumination and a vivid scarlet in increased illumination, and an impure green actually partaking of its secondary admixture upon increasing the illumination and becoming greener upon lowering the illumination, are amongst the striking illustrations that concern us here.
We are all aware that color is markedly modified by the tint of the illuminant or the incandescent material. This fact alone gives many cases of slight imperfection in color-sense the ability to partially correct their mistakes when color is examined under an illumination which is preponderant in yellow and orange rays.
varying conditions test-colors change, not only in regard to the certain peculiarities which give them their special tones of hue, but actually, as previously shown by natural illumination, to more or less cvhange in hue itself?"
Consequently, when color is to be seen practically and daily under such conditions in railway employment by those who must depend almost wholly upon the perception of color alone for the safety of life and property, the testing should be done under similar conditions before any candidate is allowed to assume the risks that are incumbent upon such positions.
An inefficiency which many have tried to overcome is the totally different values that are empirically placed upon the hue of the test-colors themselves. In England, Abney has done much toward this question by determining the value of the reds and greens as ordinarily used under gas and electric light exposures upon some of the most important railways.
This inefficiency, however, can, and should be, practically set aside by assuming pigmenthues that are equivalent to the midway bands in the corresponding portions of the solar spectrum. These selections, which may be determined mathematically and analytically by an International Commission, and then reproduced in pigment by a consensus of examination by a sectional (or even a national) sub-committee of competent observers possessing normal color vision, can then be used for signalboards, signal-lights and test-colors in the special locality given. The tests to be used by artificial light or modified daylight in different situations may, if thought wise, be constructed under the same general average stimuli that are to be employed in the future to illuminate the signal-colors.
A marked inefficiency in all color-testing amongst railway employes is the permittance of candidates with slight though recognizable imperfect color-vision to pass the examina
For example, a definite area of red hue at a fixed point will with varying tints of some form of dominating colored light (especially if the substance reflecting or transmitting the red be made interchangeable in construction) affect certain peculiarities in coloration before the last phase of the color itself is annihilated; so with every other color-differentiation.
1 Of course, a series of International Appeal pigment-tests could be obtained and used as checks by the International Commission, but as the sectional tests would most certainly represent the preponderant ratios of color in the locality in which the tests are to be employed and the signals to be used, it would seem to the writer that the plan described above is, for the present, the more practical of the two.
tion, and afterward to occupy positions where a part of their daily duty consists in differentiation of color.
There should not be any degree of standard in regard to the capacity and responsibility where color differentiation forms itself as a part of the routine duty of the employes. Such positions are so few in number when contrasted with the great supply of available applicants, and the responsibility is so grave, that no exception should be made. By this means, and by no other, will the chance of danger of admission of imperfect color-seeing organs into actual service be further reduced to a minimum.'
Again, in this connection, it must be remembered that the employe in reality is the one who is the most protected. He necessarily is the one that in an accident runs the greatest risk of forfeiting his life. Such candidate should be rejected without a particle of sentiment. They should not be accepted if they are practically unfit, even to a ninor degree, for the work required of them in colorperception.
The lack of systematic and periodic re-examination of those who have been previously accepted is another great evil. This inefficiency in color-testing amongst railway employes is truly reprehensible. It is not expecting too much that the tests employed in different routine and by varying methods. should be repeated yearly and at different seasons upon the entire personnel of the railway company that is engaged in positions where recognition of color in any important way, affecting life and property is at all necessary. After every case of severe injury or attack of illness that might in any way be likely to produce visual disturbance, the examination should be made. Amongst those who known by strict and yet silent surveillance to use any toxic agents, such as tobacco and alcohol, the tests should be both painstakingly and frequently tried.
The increased responsibility required by civil service, where older subjects, who are more
1 Just as in parental countries, unremitting quarantine inspection, compulsory vaccination, etc., are the only ways to guard against danger. So here the barrier should be placed at the entrance and no one who does not possess a normal color-sense should be admitted.
2 The fact that the differential diagnosis between a fixed congenital malformation and a commencing acquired color-defect in many cases is, at times, extremely difficult to determine even by an ophthalmic expert with his instruments of precision and his many methods of careful clinical research, renders this more pertinent.
prone to exhibit acquired color-defects than younger ones, are necessarily given positions that more greatly necessitate the employment of normal color organs than even before in the past, has not been considered as fully as it should be. In every such case there is sufficient reason to require careful periodic repetitions of some of the most important of the means that are employed to re-study colorconditions.
That these general inefficiencies so often seen in color-testing-a few amongst many of both greater and lesser importanceare still permitted, is beyond is beyond comprehension. At first sight most of them appearing of minor importance to the railway surgeon, the general practitioner of medicine, the railway official and the layman, yet without citing any of the well-known catastrophes both by land and sea that have without question been proven to have been dependent upon imperfect color-vision in unexamined and faultily examined employes, it must be conceded by all that the subject, when more fully understood and better realized, becomes of vital interest. Moreover, when it is considered that between four and five in every one hundred healthy men possess degrees of congenital subnormal color-perception that practically unfit them for employment in this peculiar direction (dangerous work that is mainly dependent upon color-vision), it seems to the writer's mind, at least, that there should not be an iota of quibble as to the advisabilty of the most careful and the most conscientious selection of only those candidates who possess as one of the most important parts of their physical equipment as perfect color-vision in each eye as can be gotten.
Green and red colors, in spite of all attempts of abandonment or change, must be used for railway signaling (and hence testing), and as these colors are the ones that are unrecognized by the great majority of the congenital cases of lowered color-perception, and are those that disappear the earliest in incipient disease, the danger must constantly remain with us. Increased illumination of signals by electricity will not remove the cause. All that can be done is to have an uniform coloration of all the colors used both in regard to hue and tone, subject to the average varying conditions, situations and circumstances in which