tion of the building, when the ground was in a rough state. Since then we have a beautiful, smooth, well grassed lawn, and during last spring and summer it was the most beautiful I had ever seen.

"We are beginning the construction of a hospital at Peru, Ind., to replace the old one at that place which we are now using. This will be a singularly beautiful building; the basement is to be of cut stone; above that of pressed brick, a buff color; the roof to be of green tile. This building is to be situated on a piece of ground containing over two acres. I should have added that in the Moberly grounds there are three and a half acres."

DR. GEO. CHAFFEE, SURGEON TO LONG ISLAND RAILROAD.

There is a point from which the hospital system may and should be viewed, which is high and most worthy, and that is from the humanitarian standpoint. Looked at from this point, railway men should, without the aid of a glass, be able to see that with this system the welfare of the employe is being properly looked after. When an employe falls sick or is injured-where this system is in operation he is promptly, and with care, removed to the company's hospital, an institution in which he is himself a stockholder and part owner, and in which, by his monthly assessments, his bills are paid in advance, an item

of no small account. Employes are not all able to be treated in luxurious homes, but their cuts, fractures and injuries are just as sore and painful as though they were able to afford the best of everything. The simple adoption of this system on the part of the company, and the consent of the employe to the light monthly assessment, will place him in a position to receive and enjoy the very best treatment in the land, and when cured he will be discharged from the hospital and returned to his position at the earliest possible momentfree from debt.

The employes of our lines are on the train, constantly facing danger, and must meet the crash when it comes. Wrecks have occurred and will continue to occur "just so long as human agents are necessary in the manipulation of railways." And since this is true, we should neglect no particular whereby their horrors may be palliated. Is it not far better to be fully prepared for half a dozen wrecks along the line, than to have even one occur with no preparation whatever? The answer is short and easy, but we leave it unwritten. General practitioners, who are suddenly called to the scene of an accident, are often obliged to go poorly prepared for the work, and if to this we add lack of system, they are terribly handicapped in their efforts to relieve.

If we have adopted up-to-date and approved methods, and done our very best in applying the same, then we have done our duty, our conscience is clear, our minds at rest, and there will be little room for public criticism. The hospital association fund provides (1) an emergency box of simple dressings and soothing remedies on every train; (2) local and specially trained surgeons all along the line; (3) a chief surgeon to direct the efforts of local surgeons and for consultation; (4) a railway hospital or home, at convenient points, where sick and injured employes are cared for; (5) a relief car at division towns, with beds, stretchers, warm blankets, restoratives, anodynes, splints, surgical dressings and instruments for all emergency work. With the association of the A. T. & S. F., the monthly assessments for the hospital fund are as follows:

"From employes' earning during the month: $30 or less... .25 cents per month $30 and less than $60...35 cents per month

$60 and less than $100..50 cents per month $100 or over.... ..$1.00 per month "The above deductions shall be made from total earnings as shown on pay rolls."

In his address as president of the National Association of Railway Surgeons, and in a more recent paper, which I trust will find a place in the Railway Men's Reading Rooms, Dr. W. B. Outten, chief surgeon of the Missouri Pacific Railway, says:

"The employes assert that they save money by paying the assessment which constitutes a hospital fund, as prior to its establishment, sick and injured employes were helped out by other employes and friends contributing to subscription lists carried about by the generously inclined, and that it was not uncommon for men to give, under such circumstances, fifteen, twenty or more dollars a year, for such a purpose. The men say that, while some might doubt the right of assessments, still this point is not now considered, in view of the benefit conferred upon those who really needed it. The hospital system has stood the test of time for many years and must certainly possess merit, as the compulsory elements of the assessments would, naturally, produce prejudice unless some redeeming virtue was constantly manifest. The small assessment is not deemed a burden by the employes, and the hospital system is viewed as a benefit.

"We maintain that a properly conducted hospital department upon a railway is more conducive to loyalty than any other existing form of relief association. It at least offers opportunity for the manifestation of that good will and consideration which a widely diverse and extended interest seemingly prevents. In the precincts of a hospital the manifestation of kindness, consideration and humanity are not subversive of discipline, but are at all times a gracious aid in treatment. A railway hospital partakes more of the nature of a home than it does of the cold nature of a general hospital. Its every element is based upon a thoroughly unselfish desire in providing the best possible elements of subsistence, treatment and results.

"We do not believe that it can be demonstrated that any relief association connected with any prominent railway can obtain from any hospital, not owned or rented, the same beneficial results in all directions, as the one under its own government and control. The peculiar influences of a railway hospital upon its patients should be seen before they can be thoroughly realized. Railway men are naturally clannish and they take pride in direct contact and in discussing the diverse experiences of their vocation; and it is in the nature of a curative measure for railway men to have

their surroundings thoroughly railroadish, and as has been said before, the homelike element is the one which satisfies the railroad man."

In response to my request for a statement from employes in regard to their opinion of the hospital association, Dr. Frank H. Caldwell, chief surgeon Plant System, makes the following reply, which, with the letters from two railway men, speaks volumes in favor of the hospital association, and for which we tender our sincere thanks to the writers.

"Sanford, Fla., February 17, 1896. "Dr. George Chaffee.

"In compliance with your request of February 8 I herewith inclose communications from Conductor L. K. Morris and Section Master J. E. Stokes. The former has been very ill with an attack of inflammatory rheumatism and has been in the hospital, as he states, some time. He is now convalescent and will soon be out. Mr. Stokes had an at

tack of typhoid fever, which came very near proving fatal. These two men are naturally grateful, and gladly wrote the letters, copies of which I inclose.

"The majority of the employes appreciate the Hospital Department. I believe if it was put to a vote as to whether or not the system should be abolished, nine-tenths of the men would vote to continue it. Of course the track men and train crews derive more benefit from the service than any others. Therefore, I obtained statements from the head of the transportation service, and head of the roadway gangs, i. e., conductor and section master. "Trusting this will meet your wants, I remain, Yours truly,

"Frank H. Caldwell, Chief Surgeon." "Sanford, Fla., February 14, 1896. "Dr. F. H. Caldwell, Chief Surgeon.

"Dear Sir:-I have been in Hospital No. I two months, suffering from rheumatism, and I will leave in three days almost well. Previous to this time, I have been employed by

this company five months and my hospital dues were $2.50, or fifty cents per month. I have always been in favor of compulsory assessments, and I do not see how a hospital, that is, a railroad hospital, could be operated successfully in any other way, and the assessment is so small I do not miss it. I would, under no circumstances, be willing to do away with the hospital. I am of the opinion that the hospital has tended to make the employes more loyal to their employers, and I think the general feelings of the conservative employes are greatly in favor of the hospital system. "Respectfully,

(Signed)

"L. K. Morris, "Conductor."

"Sanford, Fla., February 15, 1896. "Dr. F. H. Caldwell, Sanford, Fla.

"Dear Doctor:-By your request, I gladly write a few lines relative to your hospital system. I have always favored the plan of compulsory assessments of each employe; always advocated it, and shall continue to do so. I do not miss the assessment from my wages and consider it an excellent investment for any employe.

"Since the 9th of January, 1896, I have enjoyed the benefits of your hospital system, and in consequence shall always have a warmer and more proper regard for my employers. I think there is the kindest feeling among the employes toward the Plant System Hospital, and if there are those who do not advocate it, they need only to suffer the misfortune of sickness or injury, and receive the hospital benefits, to be made warm converts to your service. heartily endorse it in its entirety. "Respectfully,

I

Dr. Geo. W. Hogeboom, chief surgeon of the Santa Fe, in his annual report to members of the association, makes use of the following language:

"There has been during the year a greater tendency for married men, especially those suffering from injury, to go to our hospitals. for treatment instead of to their homes, and I cannot too urgently commend such action, as the chances of recovery and especially of more perfect recovery, are so much greater under the antiseptic treatment furnished in our hospitals, than through effort and often failure to furnish the same treatment at even the best of homes or boarding houses. Besides this, the surgeons of our hospitals are particularly skilled and practiced in the specialty of railroad injuries and ailments and their treatment in hospitals, which fact, together with the advantages of trained and careful attendance, should be the strongest kind of inducement for

all classes of employes to avail themselves of hospital care.

"When it is taken into consideration that these injuries are many of them cases of the worst forms of fractures, contusions and lacerations, and the ailments are more often than otherwise in an advanced stage when reaching the hospital, on account of the employe remaining at his duties as long as possible, this is a very fine showing for the results of well organized hospital treatment for both injuries and sickness."

Speaking of the hospital association, Mr. Stevens, general manager of the C. & O., says: "It is a model of equity and justice." Mr. W. B. Doddridge, general manager of the Missouri Pacific Railway, says:

"It operates practically in securing and promoting harmony among all classes and conditions of employes in cases of injury and sickness, the preference, in almost every instance, being in favor of treatment at the hospital, or under its control. Better results are accomplished for sick and injured employes because of the superior facilities the hospital department secures for nursing and caring for the employes, and that at a nominal cost to the employe."

There is a feature of the hospital system which, if properly managed, should become very popular and useful indeed, and that is the transfer system. As yet we are not aware that the transfer system or interchange of patients is in practice between lines having their own hospitals. The transfer or interchange of patients from one system of hospitals to another would greatly increase the popularity and usefulness of the hospital association on such lines. The transfer system not only furnishes the employe with the best medical and surgical service in the land, including all specialists, without extra charge, but provides for him, when indicated, a luxury which only those of means can afford, viz., transportation, change of climate and private hospital service until well. Employes are not looking for positions in the hospital, but fortunate, indeed, is the one whose name is on the assessment roll of the company's hospital when he has need for the service, and especially so where the transfer system is in operation, for by it lives may be saved that otherwise would certainly be lost. Patients recovering from pneumonia, la grippe, rheumatism and other diseases of this class would be taken from the North to the sunny South. Typhoid, malarial

and swamp fever cases would be sent North or to non-malarial sections of the country. The unfortunate consumptive would seek the West and Southwest, where he might not only find relief, but in time, employment; results which he would very likely be unable to secure under any other circumstances. Bring the employe, sick with heart disease, who has been partaking of game and birds, from the plains and mountains to the railway hospital on the coast for surf bathing, clam bakes and shore dinners, and his diseased organ will recover, or at least its condition will be improved..

We would like to ask railway men if they know of any form of relief that will compare with or even approach the hospital association as it now stands? Add to this excellent system: the transfer feature or interchange of patients and we have the highest order of charity ever devised by the human mind; a charity which does not humiliate, but which renders the employe independent, furnishing him with a service equal to any private service which his employer is able to secure. It is true that only a small percentage of cases would require this change, but when indicated it will be found to repay a thousand fold for any effort it may cost. Only the best is good enough for our faithful railway men.

On most of our great lines the relations between employer and employe are very close indeed. The employe is contented and satisfied, the employer is pleased with his men and proud of their work. There is an element of friendship or social feature of the very strongest character, and the desire for such to continue is mutual. Nothing could induce either employer or employe to propose a change which might disturb these pleasant relations. When we proposed the hospital sy stem, which reflects the views of the members of the National Association of Railway Surgeons, to our eastern lines for consideration, we were fully conscious of the happy relations above described. We are not the ones to introduce or to propose a disturbing element at any time or place; we incline to the opposite most decidedly. In this matter we are sincere and firmly believe that the humane and beneficent hospital system which we here propose, will prove one of the strongest ties to be found in maintaining that happy union between employer and

employe. The sun of railway surgery and of the hospital system rose in the West, but its brilliant light is rapidly breaking over the East.

"THE VALUE OF EXAMINATIONS OF SIGHT, COLOR SENSE AND HEARING IN RAILWAY EMPLOYES."*

By C. W. TANGEMAN, M. D., OcULIST FOR
THE C. C. C. & ST. L. RAIL-
WAY SYSTEM.

For some years past navigation and railway companies, many of them, at least, have been recognizing the importance of examining the eyes of their employes. Devices are patented, and machinery and equipment perfected to reduce the danger of travel and traffic to a minimum, and yet not one will dare to dispute the statements that the requirements that should be exacted of railway employes must necessarily become more and more rigid, in fact, keep pace with the improvements above mentioned. In no capacity of man's employment to-day, do we find it more necessary to select men fitted mentally and physically for their position than in high grade railroading.

No matter what the inventive genius may do in the way of inventing machinery to increase speed, to perfect automatic devices in signally, it will require the guiding hand of man to direct it all. No automaton can be placed in the cab. Dismiss the train crews of the most perfect railway system of to-day and replace them by employes of 40 or 50 years ago, and imagine the result! Men are demanded that are physically perfect; their senses should be acute and their intellect clear, and with all these requisites, long training is necessary to make a good railroad man. Navigation and railway companies have in latter years recognized the importance of determining whether their employes possess sight enough to see form at a sufficient distance, whether they have sufficient range of vision to read orders and rules clearly, whether their color sense is sufficiently acute to readily and correctly determine signals by day or night; and lastly, whether their sense of hear

* Read at the ninth annual meeting of the National Association of Railway Surgeons, St. Louis, Mo., May 1896.

ing is acute enough to receive orders by word of mouth. In some of the states it is statutory law that railway employes must be tested at certain intervals, and no man is to be employed unless he has been tested and is known to possess perfect color sense and good vision. To employ a man who is color blind is a violation of this law, and is punishable by a fine of one hundred dollars. Strange as it may seem many railroads oppose every measure to adopt a uniform standard of color test or any test at all. Opposition was even known to emanate from the ranks of this body, the medical advisors of railway corporations. These conditions are happily changing, roads that have never examined their men heretofore are now making inquiry as to methods, rules and requirements. Having just completed an examination of the employes of the Big Four Railway System, which controls about 2,400 miles of line and employs nearly 5,000 men who handle signals, it occurred to me that to point out the results obtained and the methods used in a brief way, might act as an argument or as an inducement with those who are still in doubt whether railway employes should be tested. All examiners have recognized the importance of adopting some method that is simple, in order that a committee of laymen can make the preliminary tests, under the direction of the division superintendent. In order to accomplish this I had a number of meetings with all of the division superintendents and their train dispatchers, under whose immediate supervision these tests were to be made. I explained to them the object and principle of the various tests, and how to bring out the best results and record the condition found, so that the surgical expert to whom all of these papers were to be submitted could act intelligently. I adopted the form of record blank, devised by Dr. Thomson, with a few modifications, I formulated rules of instruction governing all of the tests, and had them printed on the reverse side of this blank, so that doubtful questions could be referred to at all times. They are brief, and read as follows:

RULES GOVERNING THE TESTING OF EYES AND

EARS.

No. 1. All test types for distant vision should be placed in a good bright light, twenty feet away from the applicant. Each eye must

be examined separately in all tests, and the result so recorded.

No. 2. If the applicant can read but the first line, record it as 20-200; the second line as 20-100; the third line as 20-70; the fourth line as 20-50; the fifth line as 20-40; the sixth line as 20-30; and the last line as 20-20.

No. 3. Each eye must be tested separately for reading the small type. Nos. 1, 2, 3, 4. Record the shortest and greatest distance that this type can be read. Never use a soiled card.

No. 4. Field of vision: Take a piece of pasteboard, about one foot square, with a circular opening in the center one inch in diameter, and place against a window light at the height of the applicant's eye and at a distance of one foot from him. Direct him to look through the circular opening in the card, at some distant object, and while in this position see how far to right, left, up and down he can see some small object, as the end of a piece of chalk, when moved over the surface of the card.

No. 5. Color Test: Place the applicant in a good light. Throw the first skein marked "test" across the stick. Have the applicant select the colors that match the test in the first division. Record the numbers selected. Repeat this test with the second and third divisions on the stick.

No. 6. Have the test colors named separately. Record whether he selects and names these colors promptly. Have him ' name the color of the flags used as signals, and mention their use and match the color of the flags with yarns on the stick. He must not be permitted to hold two colors together for comparison.

No. 7. Hearing: Test the applicant in a quiet room. Test each ear separately, both with the watch and conversation, and record. the result in inches and feet.

Every new applicant for a position must submit to the above tests before being given employment.

No. 9. Should the applicant not see more than 20-40 (the fifth line) with each eye, he must be at once suspended and referred to the oculist for a more thorough examination. Do not have more than one person present during an examination, and keep your woolens and test cards clean.