COLUMBIA LIBHAHIES OFFSITE HL-Al TH SCIENCr:S SrANDARD HX64074773 RA615Un3 Suivey and recommend RECAP U.S. Railroad Adminiatration ******** Siirvey and reconimendationB , .RA61.T Ah^ Columbia 23nttJf rsfftp intI)fCitpofllrttjg0rk Collcse of ^fipgitians anb burgeons Hibrarp t-r^ Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/surveyrecommendaOOunit UNITED STATES RAILROAD ADMINISTRATION DIRECTOR GENERAL OF RAILROADS SURVEY AND RECOMMENDATIONS OF THE COMMITTEE ON HEALTH AND MEDICAL RELIEF DIVISION OF OPERATION WASHINGTON GOVERNMENT PRINTING OFFICE I 'J20 UNITED STATES RAILROAD ADMINISTRATION DIRECTOR GENERA.L OF RAILROADS SURVEY AND RECOMMENDATIONS OF THE COMMITTEE ON HEALTH AND MEDICAL RELIEF DIVISION OF OPERATION WASHINGTON GOVERNMENT PRINTING OFFICE 1920 \ju^3 CONTENTS. Page. Preface 5 Introduction 7 Exhibit A. — Letter submitting recommendations to Director Division of Operation 8 B. — Chart showing comments of all regional directors, also Federal managers Southwestern Region, on program of committee. 9 C. — Charts containing data secured from the various railroads by questionnaires 19 D. — Railway sanitary code 66 E. — General and departmental rules governing physical examinations of applicants for employment, promotion, and periodic examination in order to determine their fitness for service 75 F. — Sm'vey and recommendations for assisting in the control of malarial fever 79 G. — Separation of claims and surgical departments • - 80 H. — Granted trip transportation for local siu'geons 80 I. — Sm'vey of inspection of rest houses with recommendations 80 ,T. — Sm'vey and recommendations regarding practice of laymen being used to make vision, hearing, and color examinations of raihoad employees 81 K. — Model first-aid kit, with directions for its use and maintenance and estimate of cost 82 3 PREFACE, The following report of the Committee on Health and Medical Relief of the United States Railroad Administration is recommended for the most earnest consideration of railroad officers and of Federal and State public officials in so far as such officers and officials have to do with the standard of health and sanitary regula- tions applying to railroads. This committee has been at work since September. 1918, and has labored diligently to improve health and sanitary conditions on the railroads of the United States. Its conclusions are the result of long study and a most comprehensive survey of the problem. Walker D. Hines, Director General of Railroads. 5 INTRODUCTION September 25, 1918, the Director General of Ilail- roads issued the following circular: The Committee on Health and Medical Relipf for the United States Railroad Administration is hereby appointed, consisting of the following: Dr. D. Z. Dunott, Chairman. Dr. G. W. Cale, jr. Dr. Victor G. Heiser. Dr. T. R. Crowder. Dr. H. M. Bracken. The committee will establish an office in Washington and will conduct a survey of, and submit recommendations in connection with, the proper protection of the health of employees and patrons of the railroads under Federal control. W. G. McAdoo. Director General of Railroads. The committee established an office in Washington, D. C, but was unable to begin active work before the latter part of November, 1918, due to the preva- lence of influenza over the country, the members of the committee being engaged in the work of combat- ing this terrible scourge. Since November 22, 1918, the conunittee has held frequent meetings; has had referred to it through the Bureau for Suggestions and Complaints a large num- ber of complaints received from the general public concerning the insanitary condition of stations, cars, shops, and toilets; this gave an excellent opportunity to investigate the conditions which patrons of rail- roads complained of, and we were able in many instances to suggest a remedy; also handled a num- ber of health conditions that confronted the Raili'oad Administration to a satisfactory conclusion; and re- ported from time to time upon ciuestions submitted to it bv the Jiailroad Administration. In order to familiarize itself with railroad condi- tions in so far as they applied, committee made sur- veys through questionnaires sent to all railroads under Federal control, and inspected railroad sanitary and health conditions in 32 States. Upon knowledge gained during these inspections and data procured through questionnaires, committee has based its rec- ommendations. The committee recognizes that probably its Ijest service is along the line of preventive medicine and preventive surgery, which offers opportunitj^ not only for' humanitarian eft'ort but will make possible greater efficiency and lessened cost in operation. Typhoid fever, smallpox, malaria, and hookworm are pre- ventable from a practical standpoint, m fact the con- tinuation of these diseases should not be tolerated. Reconstruction siu-gery is ui its infancy, oj^ening up a great field for researcli and betterment in the care of the injured. The medical and surgical departments connected with the railroads offer imusual opportunity for the disseminating of information on these several sub- jects. The committee aclviiowledges its appreciation of the hearty cooperation and supjiort of the central rail- road administration, the regional directors, Federal managers, and other railroad officials with whom we came in contact. Dr. D-. Z. DuNOTT, Chairman. Dr. G. W. Cai.e, Jr. Dr. Victor G. Heisek. Dr. T. R. Crowder. Dr. H. M. Bracken. Dr. T. R. Payne, Secretary. Exhibit A. August 19, 1919. Mr. W. T Tyler, Director Division of Oferation, Washington, D. C. Dear Sir: The undersigned Committee on Healtli and Medical Relief was appointed September 25, 1918, for the purpose of conducting a survey of, and sub- mitting recommendations in connection with, the proper protection of the health of employees and patrons of the railroads under Federal control. On account of the influenza epidemic it was not possible for the committee to hold its first meeting until November 22, 1918; since that time thecommittee has held frequent meetings and has made investiga- tions and reported from time to time upon the questions submitted to it by the Railroad Adminis- tration. In order to familiarize itself with railroad conditions in so far as they affected its instructions, the committee has made surveys in many parts of the United States and has actually viewed conditions in the States of Massachusetts, Connecticut, New York, Pennsylvania, Delaware, Maryland, Virgmia, North and South Carolhia, Georgia, Alabama, Mississippi, Louisiana, Texas, Arkansas, Tennessee, Missouri, Ohio, Indiana, Illinois, Minnesota, North and South Dakota. As the laws of the Federal Government and of the various States directh^ affect railroad conditions, the committee has confeixed with officials of the United States Public Health Service and with manj^ State health officers at the State capitals. It also has met, by invitation, with the Surgeon General's conference with State and Territorial health officers in Washing- ton, June 5, 1919, at which time the chairman pre- sented a paper. On February 7, 1919, a tentative program outlining the work of the committee was submitted. The Director Division of Operation authorized the sub- mission of this program to the regional directors. The transcript of the views of the regional directors and of some of the Federal managers is transmitted herewith. The committee begs leave to submit in addition: A complete set of sanitary regulations. A set of rules governing physical examinations for railroad employees. A memorandum in regard to rest houses. A memorandum covering separation of claims and surgical departments. A memorandum concerning privilege of trip trans- portation to local surgeons to attend medical meetings. A memorandum concerning the control of malarial fever. In compliance with instructions of June 17, 1919, in regard to first-aid kits, the committee submits here- with model outfit with directions for its use and main- tenance, and an estimate of cost. Correspondence covering recommendations of the committee regarding the practice of laymen making vision, hearing, and color examinations is submitted. The committee believes that it would be to the best interests of the Railroad Administration if an oppor- tunity were granted for an earh^ conference with the Director Division of Operation, to discuss the various recommendations herewith submitted. Respectfully, D. Z. DuNOTT, M. D., Chairman. G. W. Cale, Jr. Victor G. Heiser. H. M. Bracken. T. R. Crowder. P. S. — In view of the great importance of functional reeducation of uijured railway employees mentioned m paragraph 1 of the committee's working program, the committee tiesires the opportunity of discussing this subject with the Director Division of Operation and the regional directors, following which it will make its report and recommendations. RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. !^« . wo ^« W >-* ^^ °^ W.< Wl^ ffl Ph Cf c o M Pi > 1 < g <; c 1. < .@|g III" i «■ Ph pi}:|i;ll|lj.| s 3 o (1. IJ^I^plllilJIlJi 'Eslllllls-°"sls^«-a ||||.pa^ii|j|fe|| .s.§gsgs-2a.2.eoE=s|gg ilill^l^ |.||2||if af.sl|||| < < f4 ■3g3=ia£-agt;aafe •gi|"als'S|l"!,l i|:.|t:gi?5iiii 5£is-g'3ogo>5l-9 < |gsg/ta-§: flillKcig "lilliiligE z o p i « 1. < liJi!:Pttl|iJ ii!ii;iifiji ^il|tlll.il|.ip| 1 f- t>- „^ - . t- ; §1 154473—20 2 10 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. •S.S I|.b!s< go 3ga I -T, ? 2 " ■^ gosgasi; ia-rl. §1 ofl ^ i'-s-9 «-s g'-g §1 g a ss=si .Sp.as.s 1-^ Pfti iiii »|1P I i^-^y f r.afi I ^-.3 »o"2o&a '2 „-S.tJ S'goa si's •^'o §,23 " § ^ a d(§ °^ ^ '"^ °"^ rH ° ^"^ ^ p*-a'^ i§|a|'|'o ^1 ^^ o5|| I g I ||g III Si II >.~ a s| '!sa°rlligs"Es-aa|aiig|&|'s.aaoj.^i^l |s|i;^ot,ss^g-^.||5gie3|as^|^22||^ 1 1 i g'i « fllllJII ilil^ If 4| g 5S§f 11 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 11 I "^"sS-S *«1 ! " sl s3 S.as feS s al il'oolf i J il^ 9 S o ^ •°SJ§|-a s-i'S'9^ SS'Sg.ggo-SS'S^aa jTS cc CL.-^!; ^^"^ ^ ^JiiliSifil a£ s s.< aS I •S.9 g s a1 ^ C3J3 R c3 -'■s 3 S 2 p ^ S 2 2 " fl .9|.g|iSa a|S Islgl"^ jl-s al^a-g^ af-3 s-S-S^gS-S as, 22a?.gg 12 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. lllll ||li|.a^^|S||li-=^l§1i^'^ III ^ l;l ls|l|||^ § °|| 8?gl III «IIP "It-- S 1-=^ ^pti » 1^ 1^1 11« I "S? PIB If! li sifpll ill !-4 irii!l ly^i^s ipfipi . ^ sllltilafsi^ i lilllll all fl^ -1 11 -I i.C i!§l! 1 fill III llltlsllll.&1 il III 1 iMi li.2 liff*ll i llllll 11 ill 1^1 ll II llllfll I llllisl illi ^ g^ia'^QS'^fls — "3 '^'*^S£;+^.'tHn3n5"iB^^.rtaSo"-'®>ic'li g g-S'g |S|.S S-a sS "•§ " fe-- S'Srt^a'^^I:;«a >'*^ft— '35 ■^S^iS'SSoo 2 §s22i'§1':so^|£sx32fe<„.a„-£'fl§ ~^ - Sf^aSl'^ p.&p,S'S °S"fi» ■ oag.g'g « a *"•§!& °i5^5'3 « al a «■§ g'&a'g-sSnS ■S a ■oS'i > p-ta «-S ""P « a''BS f^'° S i p.'^'S'S RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 13 ■sg^ rtJ^^gbg.Sg.gS-i 2- 3,= Bfl a^o a S '-•3:3 ; :&.Bh 3-2 &£^ S,' i~ll ilslllllll i?li isl-sll il las ^llllllls S si i Its |g| si 14 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL, RELIEF. The committee's proposal to cooperate with the Public Health Service in its propa- ganda against .venereal dis- ease should be 'approved. £ The committee's proposal concerning general sanitary improvements should be ap- proved. It has been the prac- tice for the lines in this group to endeavor to carry out the necessary precautions to see that our stations, shops, office buildings, etc., are maintained in sanitary condition. £ The advisability of arrang- ing for trip transportation for local surgeons over foreign linos as an educational feature is entirely practicable and will no dou]3t increase efficiency. I do not thiulc it possible to eliminate the pass as a consid- eration of compensation and make cash compensation fair and reasonable mthout greatly increasing the funds necessary tor the operation of the hospi- tal department. Standard fee tables without other means of compensation are usually low and a source of humiliation and discontent to the surgeons who accept them. Reason- able pass privileges for work of a limited character plus rea- sonable cash pajmients for more e-xtensive work, taking due consideration for the pro- fessional ability and worth of the doctor who renders the serv- ice, is much more satisfactory to the raedical profession and conducive to more interested and efficientservice to the rail- way company. The experi- ence and professional ability of the different surgeons along the line of a railroad, are by no means of equal value, and can not be justly regulated by a standard fee table. Should an equitable fee table be ar- ranged upon the basis of the highest decree ofskillattained by a few of the best educated and trained doctors on the staff, it would be excessive and prove almost prohibitive if applied to all. p-i Relative to the advisability of separating the surgical and claim departments of raihoads. Sections A and B do not apply to the Santa Fe lines. Sec- tion C regarding reports of the surgeon to the claim depart- ment of the railroad the pro- posal ofthe committee should not be approved. The present practice should in no way vio- late the confidential relations existing between the surgeon and any honest and fair- minded railway employee. If the surgeon i s of the right kind, he should be so true and im- partial in reporting his find- ings that his confidential rela- tionship with the desirable employee should in no way be impaired. To endeavor to re- tain confidential relationship with a dishonest employee should not be attempted by declining to report facts to the claim department ofthe road, which constitutes the first and sometimes the only line of de- fense a road has against im- posters. The smallest part of a surgeon's work pertains to histestimony in damagesuits, where of course his opinions are often discounted in some measure. However, ouronin- ionis that much moreis gained by the railway comnany being made acauainted promptly with all the tacts known both to patient and surgeon. Whereolaimsa:;ainst corporations are contemplated , secrecy of any kind should not be tolerated. Ph Malarial control along rail- road lines could be made very valuable should the railroads assume the expense of abolish- ing all stagnant pools of water near the homes or sleeping quarters of their employees. The control of hookworm can probably be better managed by State health boards. Ph Compulsory vaccination against smallpox and typhoid fever by cooperation of State boards of health should be approved without reservation. This work can be cared for by the hospital or jani nations now existing when State boards of health have authority to push it and give proper support. !^ Reconstruction of injured employees would be an e.xcel- lent idea were the railroads to remain imder Government con- trol. If the roads are returned to private ownership, it would be practical for the railroads only in case a group of roads representing a very large mile- age should join their efforts and provide ample funds for reconstruction work. RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL, RELIEF. 15 w Cooperation -vnth Public Health Service is highly essential and railroads pass- ing through communities where no rules concerning health and sanitation are in effect are seriously handi- capped. 1^ All structures in which em- ployees are quartered could, it is true, be screened and imme- diate premises maintained in a sanitary condition, but it is doubtful if employees using these fa'-ilifies would take suf- flcient interest in the matter to keep screens closed and effectually keep out flies and mosquitoes. Some improve- ment' in conditions might be made by draining ponds in neighborhood of sleeping quar- ters, those that it would not be pra-iti able to dram mieht be treated with a little fuel oil; water cars could be occa- sionally steamed out and this would probably go a long way toward reducing malaria, al- though to secure the maximum benefit from such a course would require a uniform and severe sanitary program on the part of the various State, county and city health officers. £ Suggestions applying to trip transportation over foreign lines to enable attending sur- gical meetings outside of their own territory is considered a good one. With respect to passes, as a basis of compensa- tion, it is our belief the local surgeons at smaller stations when given a pass for their services are the best paid men we have, due to the fact that only a few cases are treated by them. It is understood, how- ever, that soe'^-ial services, that is, calls of long distances, attending wrecks, etc., carry special compensation and bill is rendered for loss of time. Atlargerstations and division points, an approximate close estimate of necessary work can be made and a monthly salary appropriately established. PM It is not our practice to ap- point local physicians or sur- geons because of their capacity to handle employees from a claim standpoint,"in fact this ability is not taken into con- sideration in any instance. [1. Much can be done by the railroadsin the matter ofolim- inating malaria, but without an intensive campaign which will interest all communities to a degree of intensive action it is thought that very little concrete results would obtain, especially in sections like Louisiana and southeastern .Texas,' where "railroads run through large sections of swampy land, and to drain right of way would prove ex- ceedingly expensive and would in return avail little unless the communities and adjacent land were likewise drained. 2 1 It is believed the suggestion for compulsory vaccination and inoculation for typhoid and oUier diseasesis a good one, although it is a proceeding which for apparent reasons cannot be applied by the Rail- road Administration mthout the action of State or munici- pal authorities which would be appli-able to all citizens of a community. 1 ■Wliile, of course, the medi- cal department is \*i tally inter- ested in the reconstruction of sorioush' injured employees to enable tliein to eon tinuein serv- ice, it is also a part of the safet\ work and could not be siuee-isfiilly handled through our Ih'sniiiil organiiation fur- ther ihan is now being done, whiihin hides the appli"ation of anii'u uil limbs, eyes, etc., for I he 1 la.Non that only asmall pereeiiia^-e of employees are permanenily disabled, which would hardly justify the out- lay in equipment and appli- ances required. It is sug- gested that if arrangements could be made, probably through State or muni' ipal health or other authorities, to establish reconstruction hospi- •tals at principal points, it would more efficiently, eeo- ■nomi 'ally , and generally satis- factorily take care of the situa- tion. Again, it has been our exjierienee that a large number of employees who are perma- nently disabled make settle- ments by court proceedings or otlier\\'ise which are so far from satisfactory that it is prohibi- tive to consider reemployment, even in a less hazardous posi- tion. ^l^pSg a 'i>t'i'^' Seagal £=§§< S£Ssa-a M m cs 's-:5?>a^. as.; 9§sa's'S-fflSid fl 2 ® S*^ ■Pl §.=; "^'^ »= I S S-s ^5 1^ " a o.a g'^l jail s g.- o e.g 1 1 o s g'?f£=j'=1 s§^ la ^.1 1 ^3 ga » a M«@ s'FS s^ -^ y.2« " c d SS|.2gg||-p.gg^-9*'|g° .2 PIUS'S igilg^ >fl«-*'«£3 ;?€ 2-' ag'£-s«p^S~J IliPlllsiifslii 154473—20— USal sS^l i-=3e ^-om.a3 03 lis sill .as'ssi'? 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S'w) 2 ft a i §2'^ J3 ^ 1 o s . .-H a^3& p s X VI (SK § ■§ oM a § "s .^• £ £ «£ g "S-ls i' s 1 Is 1 S |9 |p- = li'g 1 ft 1 £.3 -.; 5 fr, l| .a^'^-^ 8 ■gg w"^ g s. .Ill •1 -Sj ftS >.<^ >.o d o-a 6 6 i s . fl " ^-2; gg >H 2 1 Z <~ o > W z z 2; z z 1 Z z 5" II III; S ; ii ' ■S 1 1 1 1 a • £ a ^ : si : fti : 'i'i t^ 1 5 ll a •§ a aa i 1 : 2 §a : s ■s-s : ■§ as X £ E 1^ Jt la ii (S '^ s s« c sa ;>^ Z «'"« < N z >4 << >l'" >J j^ 1 2 i2 P^ 2?4 1 • ■ Ji i 2; : • a 1 K : ; 1 a ^ K . ; : w4 (g S) § •o : T3 >> Is 1 1 1 1 i 1 rid ^-g |g ! i 1 5 ^ s s s -a % a ^ H^ 1^ gz p 3g z Z m Q < ^ >^ >< 2; z z z 2; >■ >< Z Z z 1 I2 1 ; ': ■^ .2 i ft « ■ § St' TJ ■§«■ ; : (S § 1 >-. a ft a 1 1 , a U 'a a •a s 1 * .a ^ *" ■ «> jjg 1 1 "J cj 'S sS- c c Ii c 1 1 ffl Sm R S,a 2 Z m 2; - !>^ < 2 2 1 Iz 1 i-8 ^1 1 i 1 1 f •^■o +j ^ .^ .^ bjO tx i: ■§§ "§ t o a t .a .a 4; 1^ ■a«-g -il , J2 c 1 = 1 1 2 2 1 .S ! ! > > z 2 Z 2 2 > 2 2 a 1 . n 2 i i ?^ : : i i J II : -a .g id 1 : : o i ■^ g fl >-.>, 1 5 I rl 9 :>€ ° i 3 « 1 tl^ ■ *^'a g 1 Bo !«' . s is "Hi 1 1 ^ I § g *■ >> i § 1 1 8 5; > a : ■SSa ■• a.g^-g ' ■g£ ■Ha . a g ■§'1 , 1 1 '■ 1 1 1 o "Sm as >■ 2; m' p < 2 B R°;2 2 2; 2; >^ > I>| M f- p 2 2:^5 i,^ ; i s s-f.& i2i2 ■3 23 -^ ftS^ 3 fe ii fliO : : m ■^a'^l ,2*1 1 3g| g ■53 3 . g • 1 1 !fi| Tala Hi a| s.g c j. 1 ■s : ■ 1 • i ^ : i g 1 G o S5m m?; 2 2; 2, Z ^ 2 ? Z 2 ; 2 5 1 Z2; g s 11 ii i i i 9^ •1 ^ 8 l| 1 5 '■■§ a S ;i„2;g f Ii! 11 111 Sla^Ji a| ■|i'^fH ll P^lllllil. 3 o c: a S'fi ii-a a- OJ o =« o R £ aT3+^ B o gS -9 ■II ll IflJ 1 i 13- 1 3 'fe fsl Ii 1 ji liP 1 o'a ' *.§ 1 a-2 •= g§ s |a -^ sa.gs 3 •a' = 1; ? la |a^ ^ 1=1 -^ 'g nd ^4J ^3 a^ .23 R W <; fi >3 a -^ i^-"%%°^ "^c 5 •< o !! ? = ^ *^ 2 c- TJl (. • f- •« c : :_i.s C 3 i % ;■ s s 3 S" J 3 s :i 5 5 'c ? 5 E ti C s li RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL BELIEF, N ;= ^S ■p S & 3 = is »3a :s;>H zzzz zz |x Z m z 5 SS P^ f'^ 1^ Z I— I 5" z 4 pj2 §-■»■ 5 9 I a>-.z Kn5 s"o S"a z z z >^ w :^^ ^'"S 5 a ^'o b q ? p'S^^a 3— i: £ ,i:a ft*;* a ^ ^ 5'„ g «_r^,2 = ''•^S ^'q;-2 H-^'-a t._.2'S 1-; a a g v,-^ I- "^ a » o "> o a 2^ M?-" a o * c -m o « eacs ^ £S,a o^^S-o o o « ft«i 9.3 2 a o,a,a 3S i^aiSiq S.; 34 RECOMMENDATIONS OE COMMITTEE OiST HEALTH AND MEDICAL RELIES'. 2 13 ■a -i 1 rt a^ I- «■ sfi i 1 a* § ■ 1 13 c i a 1? a s •si ■t^ o If ^ .5 i ! 1 1 1 1 fio f_3 ■OO-^ rr o s> ^ a- 13 CJ OT m Pi (D CJ U c; ;e S w R a >> — • ■=* -T i> o S © N^ li, o [i( O •h' s s s s R >H !" ■ Q 1 ~1 1 1 j3 A •? 'S'^ i i. d] (a s rt ^ C d il ■%%%% a •a a ■I 1 CI ago a s 1 fc'S- s si, g 8 g P, P, 'S'O o o S .9 of i §.•0 M ^ C) (B-3 O b fl H gg^t5p.l-B W h (£ o o w H CSm i i l.l ■s fefe 'h ^ p. a 'a a 1 >-* jr w w ca s ig OS •3 a A P . •il ■go = 1- a t 1 3 ^ Ml 3 Is E T Srt £ S'S o g ll ^ S d P..2 o K f^' p , ^ J? ►^o J >^ ^ t»'> 1 1 ° s 1 ■a «■ ■g ■*2 - p 5 c= — >> 11 1 ^ o P4 ■i || s'p< s s 3 I . ^ > i : J 1 1 ill Ig 1 'c C P-. f: f t3 &o a a s i i Pb ij , 13 E •i a si ll o p. g 1 C M K OD ^ 2; R ■. ■ o ^ 1 M ° ■ ■ap . M- m ' .3 "d 'S a^-l i |li|i|i 3 1 ' il P. III c c ai i bIPIsJi 1- ■ C c ^1 II s ! 1 i § s 1 § 1 ^ 1 lllataa- lis 3^8 g-gti 1 £ 1 a 1 p o sa w 3 .^3 o s ■^■^•S p. a S|-3| .§S2 "^ afl 1 3 £ oj £ a| 1 O c3 1 1 a s-3^ s»a<§| ^ lllll g 885 c .2 "^ m o 5= c. m w e o N § S SCO R fq Z (§ c £ II 0-2 1^ i o * g "--^ . . t iifj 1 2 ■Se- al il i |i h Iiil:i3||l.iil|| |=2||5-|s|||5-|i|i|a jiiJR:lili 1 tg|a||.slla!-a I c 'J J il N CO- >^ « CO t^ 00 oi o das 3 1 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 35 3«i .^ Id Is s ■s'°§ P 2; B ZQ !5 CO P o : :^ ■ Z a 'SftSs •9 Oiv, ■s||S la ■^•: gE^sa Sop 'g. z ■5 -a ^ ■s- g =5r O a-j; -^« •3-^M a 5-" 'm i r~3 !3S i i |5;.-il S.1 gill s-l i^l^ ill il II i|||i Sa S aS g P.J3 P,oooSj3p,g„ ^ g.gp-SgSp,^ Sn f Sg Si 36 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. > > M J*" 8 g 1 Z 1 W t>i g pi 1 £ s *^ •" 1 i ^' 1 s S is cj •- K £? Ssl o' ■ 5f!i ^jj^ ^P.;j ^ aod d6§6 6 6 S § § gg > 5)5^ Mgz; g e?;:? ?;2;z^; 2; Z W !? !?; ZZ , .0 1-, : ^. ■ J : •" -c '3 • a : K : i § |.g ; a a fi ■ o \ 1 • S a.« a >. 1 1 ! ;' 1 ^ • 1 1 i 1 2 ^ if |» 1 1 •5 ii a ■c a ! jj is %^ s ^ 1 §,§ ^1 S, s -2 a i al s i 1 H;? zrto s o^^fe gz2;>H >, 1 !>^ ?; 5 gJhJ • o : a : fj : > : ;j ■ ^ • HJ ■ S • m : '5 : .us fl PI : ^ : s a s a 1 ^ ' t; ■e !■§ : 1 ; 1 1 f^ o ■CJ ^^ ; " tJ3 2 : '^ : ; ^ : f 1 p 1 a a 1 Z SS2; o «• ?j?ia ;5Zo ^ OK?; zkzk !>. Z ?; !z z Z?; 1 .i ; •§ :' 1 :§' e K • « : a >. '§ K-^-D c ,:3 & a 1 1 I a s &1 c3 & ;S § 1 i g,o s 3 Si? ■- ft o +3 p, 03 p. 'F S-a la T "0 a .1 ^> : 1 ■°a Si 1 ■SSf " al i ft 8 O 8 c S,2 7I ^ go c I s" t c 1 •2 g Ii S a o S :W R S IgK go:? E3 glgfe fr. -^ ^ i» > z ^ i: s pn ^ : : tT : ; : a ; i \ c K ; i (2 : § : "^^ « : ; of i 1 : ^ g ; : .§ : : '3 +^ 03 : 3 « N 1 i 1 a ■§ ; 1 ; : a : « s ■ ft : : o : 1 « o> : : &>' : : £ .§ ■§ •■-_ II Id c> ■ * "C 7 i c s" s s i ; = 1 1 ^ ^ > >< m ;z; ? z ZZ Is il p. • 1 •■ • g § : ill ig' 1 1 Jill 1 1 -HI « 1 is ii ^J„ II s ° 1 si J 1 1 io 2|||'S|=s|s aS|sS||S ■Sis, --^ ■ lSi|lii.llifS 1: !lifllW!l!lllilillIgl«fiBil: 3 a& i'S * t - ^- CO ^ 1 .C ^g III 11.1-°-. 2 -il ^ S a sla » Hag i!:|l g,l.aS,2 l^"^;:^ 1 K ^^ s s a K ■< s s s < ^^^g c i < 4S ? : ^ ^^ s* To'-«* ci lyi -^ 10 irJt^od oiowcs h 10 r^ a Q • '^ CO ■«jt to r^ CO •- •* f- ^ '" "■ ■■ "" "• ■" "■ •" 4 c '^ ■1 C ■» c ^ ? m CO 1 RECOMMENDATIONS OF COMMITTEE ON HEAI.TH AND MEDICAL BELIEF. 37 f: ?; Ph J >< 2; o ■3Q0 2 ••§ •S^fc s S g ^g; ! 2 i •S-irls-i'l I: =1 I's s«-§sl 3 s' p.r.s°2ngi^S"£> «-^ go ■"af'sa a "^° IseiSei ° iSel '■t'^l"?^ o hj o &, a 'A 'A ■^ ' s 6 ■< •§ a ^SfiS- 38 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 1 1 "a >,3 1 .a 5 i a •3 t>i a §3 1^ Si n " ^^- ^ s.? • ul 9" §,.§ ^ d aS- ■3K 9-ca| g la S d g 5'B ra III. s.g£s § ia Is ^g 2g s g H >^ s t" 15 a >^ tH 1 1 1 Eh a^ 1^3 : SiJ • : SS : 1 ^ i a g : 1 : ort ia . o • & : 1 ■ 3og J 1 i=^| : 1 a|u i 1 c ^1 ifto 1 S .a : 1 ■ i i 1 3 S-^t» P siz; iz; iz; Iz ^ Iz; 5 H 2; ^ ^ ^ ^ 1 >H ll : ^ 1 2; ziz; 1 ^i J . i : az : 1 1 ^ ■c || i ^ ^1 i' ^ 03 i i" i" . il ^ 11 •a ^ o'.g -J 1 dl ■:' ill 1 1 •g -§ II it = s 1 Igi .s'Fas k !| .1 : ^ n So ss>h2; Z •^ < ;g ^ z 'z 2; t« 2; >H > 1 1 1 1"^ Ig :| i« • .g ': a a : 52' i h| ; a : «■" 42 g "g ^ -4-3 *" ; H ■ : Hg 3 S -e • •0 ' " : S 1^ 1-5 ^ ■'^ • till ! il >> ft blanta minals Ga. iri 1 ^1 i- "?■§ o c .2 >, :§ s '• t , ft ; i i a 'A SSm ft c-ilz; ;5 Z Eo S «1 S Z Ig 6 tH 2; ,2; Jg > 1 1 1 ;! In 1 itsBa ■ .g" : ■ M • o ceo © m ■pl ft ^ ■3 ^ ;■" to - : 1 Is •9 till 1 5 c3 2'3 C i S ft of « ^« 1 S^l i g £9 1 §1 c ^ c c i ■ 1 i 1 ' i 1 <1 S-Sm O ^^; 2; f5 ?; m h S fr^ 2i !3 >^ 2; z z 2 ll « 2 il Zm 1 lid' : ; . ce : : tj ""a s ^^<, : : oS : i f |m "> ■ i ' » .^ps :« ^.| ; • rt CO . .1 1 p ■ 1 ^>,s '■■^ < '■ : S .a 'C n S > 'S >> ^ 2-gwg Sop- is ^5 1 ; 3 s'^M ° -S 1 \ 3 i« i- ^,-9 : o' '^' c ■-a S3 .g o ^ ^ 1 ■ c i ■ 11 " ^ ■< «-StS n ?3g >H ;a >< « fH ^ 1; 2; 2 g; 2 ;z ;? >■ g : K 1 Z ; an : •i i ■ ' ^ . ■ g : ^^■. '■■ 1-9 ■ ■ SP '■ s f s :i. ' T3 a ^ .3 il^l I ! 1 i iJI .§ ft a .2 S n J o' S c E^ 1 1 a 5 c J ; 8.a| ; i < 2-gto fi ss; !« ?^ w go 2 e !>■ 15 2; 2; 2 2; > & m !2 ■^ ,^!5 , j §1 : : 1 ; 1 '■ a : gi . : Is ; 1 1 1 ; : 1 1 .1, 3 ft : ass : i U 1 .9 i i ^ I g 1 = ; Hi i i Ml I ; -< istS o;!5 ;z; :5 m so ;! e >? ;2: z 2; 2 2; i> ^ ^ iS S ; ^ ^^^ 1 1 : p, : ;s 1 ^^3 as ss 1 Ig |-2 g|| IS -1 s^-. :| 1 || s -^f si lii! i! i|-9^a%^t if i!li HUBIlll illliiliPHilll l: 1 ti ^ i -is . -life ' ^o"a5 = S3 « "•Sal = ;lta 5 va' ? ||:|f| ^ 1 ll lit : 3 o| M_^ ^ li §11: i Eg '^l^l 2 4 o >: ^ i 2 t 2 3 s 3 J 5 J S B ^ ! ^ ? 3 5 i i c ? ci c 5 § R ■ C s 1 KECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 39 ^ c c No. Dr.E.C. Underwood, Louisville, Ky. 1 1 1 ' Is ll «"* 1 Operating and me- chanical depart- ments. 21-45 operating de- partment. "Nn z p, 1 ^ 2 2 c 1 i 1 .1 2 2 2 1 2 2 £ 1" , ot i 3~ ■3 ■ & . ~ d ^ •a, d| ■a a % 1 1 1^1 ..&.g s 1 ,» S-SSs 1 !l li J la = sfiaes >< > - ■l.-l II 1 ill . 1 :i II S --D .0 3 « S 3 1 o ^ i ^ S Kg ■ft og w n 5 1 !z 1 2 Is i ■ ■a agate 8 S,a t's c O o S ■ lz •z 2 2 .1 2 2 2 ^ 2 ll 1 c 2 ■c II o c 03 ^ VI ■3 ».9 ■p. t^'l 2; c 1 1 p as liL 2 Hi 15 2 2 ^ 2 2 2 2 2 2 .1 So 1 l-i 1 fl i £ 1^2 ■ll O i fe tf ■ ■So o| a'S" 1 i 1 S c >H 2; §, 1 ■a . sag §1 |a| (B a u- "J . ga '»?^i 2.3 =?SS-Sc H S !z; 1 2 >^ 2 2 c 2 jS 2 p. i B 2 2 2 s .3 n II . 1 II 1 ^s- il 1 1 7. p E 1 il ?: 2 £ ;" 2 2 >< 2 ^ 2 1 ■ 1 ■0 fe II 1 s" 2 c c 2 oil K is 1 .9 o 1 iS 1 ill m o 1 2 Ma ■a.s"" 2gg >^ 1 2 2 2 2 2 2 la's ill |.g|^ « 2 2 Charleston & Western Carolina R. K., At- lanta, Ga. ? c 1 a| 1 1 1 1 « 1 1 IZ 2 2 2 I 2 2 2 1 2 2 c c 2 :2 fc £ c "a 1 '4 1 i •31 ^ Is ^ as 1 1 e 1 1 ■| c 1 1 ■o > g fc 1,3 a 1 If S ll i £ il at g 4 1 .| a i I I a 1 6 a = 1. 1 II « a -i II c ^. i 'a j: 1 E •§E Is 5^ £ W ? III a t il a i .3 > N p ■afe a "at •.oE 1 g'E 3 .E £ 1 1 •- C '^1 1 1 -E a -1- w t 111 saE c 1 1 .2 ■^ § ^ 1 1 111 1 1 ■al |S s 1 1 1 ,1 a g n S § iil 1 i 1 1 1-1 40 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. M'd a d> i e> a " a If ■^•d i ■g II 1 Sis 1 1 ft Ik «-il C^ K coo d o a-Sfld d do o d i o d d ■i C o o o a 2; 2; z 2 2 O 2 2 2 2 2 2 2 2 2 2 m Z 2 22 i li 1 S r- 3 s Pi " « 3 E .| 1 o^s t h| 1 a "- ^ « ^ j j llw E^ S tin d o d d 8 '^ *? 'c3 6 6 o d o o d d S c 1 '^ J 2; S3cq P SZ g 2i 2 P B S B 2 2 2 2 2 2 2 2 i» 2 2 2Z 1 ■^Ka" : ■§ s d t^ »- fe|a : 11° i$ : -^ M ■ O « III ' ^K i oJl" H ^i • ^ ft-^ 2 be a ^9 .s • 1^ Ra s I 1^1 ; §£. 1 ^s" ^ 1 >s ^ O 5 2 CD c 1 g s 1 1 s pl.ii 3 ^ ccSm P S )zi tH ;?; m "^1 o ;! O >H 2 2 2 2 2 >H JH ;z: ^ 2 1 22 1 : ^1 5 1^ '. ^ : 8 1 1 S ja g 3 -g a" a a,^ I i • a ; i ■ i ■3 1^ ■Q P H >.-3 o 2 S c c c 1 1 a Z S-Sm P S 2; >^ 2; m 2 B S 2 2 2 2 2 2 2 2 2 I p I;? 1 pj .is • J. 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'• 'a. ; Id' p. ^1 1 . j| 1 I J £ Si's c 'fiLil „2^£^S i.i II n S 6=2 SB'S .£ i^ l§|-.t|.i 5.1 £.lisl|-i|il • s.'i'^ailllisl i o^i s £ a^ss al P W -i; S ag g aa :^ a| .s^ili" .il ola.sli il fes|;il h3 |p.^a|f o o g "i: 1 py ! 1 i| l| \ ^ -a la's; °| ■] S "1.3 1 fa £ lliillp a.3oo£ftSa.a2f P < Q K ; 1 c ,: |i il 3 i2^ S . |l a la 1 ill i E'° S" a llll 1 2 ri 2 t- Z S - -t ;£ E g s g S S S; 'c g ? S S gSra < RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. J3 -3 o9 -^2 go p. „; : . -a C5 2, S a ►^ 9 a^ § S'S 1 O-o 3 H |x !« |m >< Iz; [h >< < Jh 2; P5 Sa ''S - .Ill tag's gS'.ai oS Ijl ^; z z J5 z •31 2; Z Z >< Z ■a Wi 1^1^ z z z z z Kg- ■S : ■s J J : ^ esz ^' ■ ^ a § a : 2 r?; it 1"; <H t« z z z Z !« >- < CO z 6^ " ssz p'gz z z 3 .3 Z Z Z ^H Z ^•s : : •SZ p ^z z z .9 & g.^ Z o o z z z z z z z . If- ■■§ :« ? -si's o i Sa -ag i'^.S -fe ^is o S 'S-S 9 aft' a'5 ja " || =1 I ■2^ a| §|P aw °"" - - " ■' a '^ rHi«^^ ^^o •J^'- °^*- "fc-i/j _-- „- _,., „ „ !■« a?§i 3§ 5^ ^ifOj ^J.2|^l|^- -yg& i9gg ^1 -^ c. % » .- 154473—20 ,2 * O IS -1 -e 8 S ^ 3 irS 1 ll Pi S "^ a S9 a 9-^i2 .2 -g.gS ,";? &99 p£i'Ejia£ < ^ is 41 42 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL BELIEF. 1 P3 c c o 1 S o s a J i - § '^ .a i 40 per cent. Company surgeons. P c C 1 13 i! ' 1 fa£ c 3 '■. ': ai-g-s o -g ii ■g'Sg .SB SoJJ 9 " S •a S "SW-E r- j j 1 §■ e, - i § S 1 . 1 c p 1 1 1 .g .g a ■2 o c £ •5 5 1 e c ■ e Is II i 2 1 1 1 . c c p 1 I a 1 Q ^ c 1 o 1 •3 •g i o c ill" i oa 4 c 3 S2 il ■ § a£ . '§ i°? £ s|a 1 lip •S 3-S'Oc So c 1 > i II a - •11 1 ■g 1 K f: 1 -^ E T. c P 1 1 1 n t: a ■s s •3 a o ■c 2 1 6^ % il : Ills c p 8 2 s li c c c p 1 I a 1 t: > Is ;§ 1 s 1 1 1- 1 ■a PI'S c sl •§ 11 1 O Q 3 J! is i 1 a S 1 = a i ^ II <: 1 P 1 c 2 T 1 "E e 1 1 C 1 1 5*° 1 1 1 ,11 J if i '1 1 1 a '% Is 2 2. c 1 2 1 1 1 ' i P 1 1 \ 5 J i 1 1 1 C 1 6" i 1 1 [ •J Ic j2 1^ p: 1 1 1 i c ;; j il P1^ 3 1 si £ .1.1 ! « c i ' W 1 2I 2; ■as •a'f -a a 2e % l| tiil 1 ■ 5 3 ° "c E| a^ > ft i :| I 11 1 1 ^s 1 fi S^ 1 .2 a « f'l E 'S-2 a « < il ^ a.g 5 Is t li 1 2 ft 8 g a ■? ■S J ill Sg"Z ia|. 1 E ' RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. l.'i 1 o I E c c P p ■• 1 3 a 1 1 1 w i § 1 ^ i § i Q P 2 J. 1 £ s o 1 1= s •3 Jed l« gS o 1 B > i 1 i & .1 5 g u -S3, 1 1 1 1 1^1 1 ■ III. 1 rill il ' t •3 •al P 111 •s ag a 11 1 , i i 1 :j tS & 1 1 1 1 a 2 a af S c 4\ f 1 1 a 1 1 1 1 1 C 2 a •c 1 a 1 3| : tils 1 c a = i 1 1 P 1 I a 1 : 1 ^ -u 1 o w 1 £ i 1 i 1 1 : S-1 W c 1 1 P 1 2 = nz Hi .11 -3 o 1 1 £ ■1 1 i < ill &5 ^ :<^ : ' 1 1 o c 1 P 2 2 • 11: »« i .S a 5 III |.sa| o 2 1 1 p a 1. II Jo So . 1 ■u i 1 1 c ■1 1.; It ga ■ §3 « 1 E ° 1 1 P I I ■ 1 "C X i. |i c I 2 i ji . :£ I'i 'p. 1 i if 1 i'f ,1 Jll ' IS 1 ■ i 2 ( if ■^ i ■c I Si s ' HE 1 So o r ill! If Ji|.|ga ij c 1^ 11 si ^- 1 •§ a 'j il c 'a a 1 .2'S 1 a-° s 1.2 ■^ |g 1 llll §S .a" ^5 E •'1 '1 1 44 KBCOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. pi pi O '.£ 1 Gulf, Mobile & Northern R. R., Southern R. R. in Mississippi. I a 1 o 8 o Fee table and a pass. t .a ■| s Its b.a c 83 per cent. Company surgeons. c 1 1 z Division superin- tendents. No provision. Federal manager. P I 3 T si"- i 1 §s|| i If. •z 1 O z ;S A ■ a ; 1 : 1 ¥ a. E o 'Z t: i |S s 1 ^ td 1 c a g « ft ft s 1 P 2 Ss o - ^2 Pil a & s If fc c 1 1 t: Pi 1 P 1 2 .1 Louisville, Hender- son & St. Louis R. R. 1 1 c 1 I 1 C 1 .1 1 1 [1 1 J 1 1 a c 1 t 1 ^ ;^ a o t: i z ;§ps p. f S Ir b £2i g 1 a '- oa 2; E sJ 2 a 1 a 1 ^ a t: k 1 T , i ^1 si ■« . £ b" TO z 1 Z c 1 C 1 2 c 1 •1 1 3 o pi'j pi 8 1 > T i § 1° ■ggt il ill 3.rlf gov f si ..gi •§1 II ii z if ftl IflM '1 Mg S S = ■"■S a ; ill ill III >,eE ftS'o c |,| OC 1! J 2 ■Ii "Is -5 ! •ai s.? Is- 2 < o ^ ■o *" i ^|,E If! ■§*■ n ■a .^ Ii E ^ 2 ^ -C S EECOMMENDATIONS OF COMMITTEE ON HEAJjTH AND MEDICAL RELIEF. 45 ^ i ■S 3 "8 Ml ?. 1 i i 1 L nil- i 1 (-I'D •gg-sS g|q I'll ^1 £ & 2 1 o d li!l oa O Ofe m -^ .n S g S o o Q Z Z 5 zc i g 1 1 i f 1 i 1 1 T I si : ■g« II S '^ 1^ u o i £ '^ i 1 ^ 'Z -a-c w £c o CO m z z 3 Z z Pi z ^ 1 H 1 "^-c ichmoad, Freder- icksburg cS: Poto- mac R. R., Wash- ington Southern R.R. 1 1 J t: 1 d 1 1 c o £ ^ « £ o iS < m Z =.,3 Z o ^^ >^ . z — ; ; M 1 £3.§ fe 1 w^ <3 . 11 1i ! 1 ft 1 t a 3 Ii 1 S3 g iaSgi a, -K a> o O .3 O (u ^C o fe 1-^ Z is e o c z f^ o ^ c '. c M •a ■ fe ^ || § 3 : tr! 11 11 . s. i - c 2 i I ' 'So c i 1 1 i 1 1 p. .!^ - g 1 1 1 : M : iz fee 6 £ <; 6- o Z s s s o o e z z i"i£ 1 ■g i g l« i I 5 Q • Is « L a 1 C « M TJ ; 5S II i: !§ s 1 ^ " - 1 p. p. "S 1 s la"": c z c QP^ 3 s z d S SB c >- " z o : j S S ~ 5g i : 1 1« ij '1 s, fsg J '3 3 1 II 3 X ill s-a-s "2 ?3 o O ell's |aS| 1-2 Se z CJi- o ^ ma ■4 c- 2 3 S o Q C z z cZ Zo c3 r-^i '^ o 1 |«l a 1 1 "s a i i . S" ; g 1 : i ■3i 1 3 1 2 1 1 t o ft 1 ■ i • 1 1 ^ 4 a c o 6, O o ? ' S S P o : c z z ^ : -^ 3 .Sg Z MS-Saggt-.s aegag'o.gS^-i g a a c j5 1 >. 1 1 II" Is 1 1 1 j 1 ..i 5^ ^ 1° 1 » -II S^ ? |l 1 :tlllill!^lllii:§^|§i l.lt^sli :llls 1= oil s lillSl £-1 il fstlil E ■ii ll 1 «- r; i -f «■ a j ^ S ■ c ; ' £ ■^ 1 46 BECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. «5 C i a , 1 i 2 1 ^1 1 5 1 •: 1 It' 1 » 'C 'i ^ S _ S ggg s 3 S'B § C =■ "5 5 1 aluth & R. R. Minn. 480. 3 |gs. 3 i 1 1 'g 6 6 "id S c J 1 i ill fi 1 - nw ft ;5 I ^ z fC « i^ s Z Z ;z: z ^ Z 12; >■ Z «} P Z Z(§" ■i^s II i ■^ 3 g d i .i a o 1 a a licago, St. P Minneapolis Omaha R. R., Paul, Minn. 87S _ >n 1 1 1 1 i .1 £g- i'g i ■^ '11' . S -ia •a 7S J 1 c a "^ 1 p. ' c si s: c c C a a "eg ■g g at C IB 1 . ^m n" S a tx z P o c &5 Z P=. Z Z Z !>H >- z z z ■5*"'zz 1 bicago, Milwaukee & St. Paul R. R., Chicago, 111. 1.463 1 c 11 So 1! g, > 2Sg §,63 IS : i a s ll •a a s %. a ■ 1 : a a : o S com p g z z z n g o -^ o ?- f^ !" >^ Z Z t>H >- <^ P" z 1. II 1 a_; g _i 3 o" § t^ S a S 1 rt-g gN i 1 •2 ■a P c3 "S " o H? S o V (B 1 «!« .a c gl ^ g. a Chic R., 2.14! r-E cfi d o 6 >,§. o '^ o d d S d d 5 d d ( c £ a a a -Sm fi <^) Z Z Z M Z f! z z z N z Z Z Z z >■ < z z z zz- la § it i a 1 % .^ §* a ^ OP3 fcc p .£ a c gg.S •is 1= c S.S s l ■ II 1 " g .5+^ c « O t> §2: g Z Z Z Z g O 1. o 5 ^'" Z Z Z >- !>^ > 5 1 z R ZZ 1 j3 r ■SPi a ^ ^ |.Si£ v= g Si .a a a S.& '^ .s <3 §.3 ft " (H-^ 5 a %'S. ;iicago & N Western R. Chicago, 111. 1 Pi s| fe'^al'i ® g " O 2-3 a >> 3 >i Ill c c II •2a a- I l >> ;a e ^ fill o 1 ^ M^ir a P z >^ z K S '5 ' " rH ^ fc. Z Z Z >< in ^ t. 2 1 m°'"zz a - g SS t ^ o =3 5 3 -^~, 11 B a t 1 i 1 2 a rt a 1 = 11 •^s C3 g Is O " f 1 1 i L a 2 £| 1 •las g i2 c cJ d d S.S i 1 '§.§ 1 j d i d ^ ' i k ^o S 1 tl ii o -S2 fi z z z M Z t' s e z Z >H Z Z Z i» > < !>■ z Q zm i 1 a .a %. 3 (§ g 1 i £1 'C '>^ CD oPi ■ t w3_ s 1 .o 1 «l -* V .3 ^ g Ti o n pjl 1 ^ s a i g.§ i si %. \ - N S i gl 1 cq -Sff z z z z z e; a S z p^ >- z z z '.^ > ^"^ > 2 Z ZP I 1. Name ot railroad. Location of general office. Number of employees: 1 1 1 E J i i f 1 1 I 1 a ^ 1 ^ i! HI fl llilii az-|S| II 2| a^ a^t? ga Sgl i'g oS 1| I'a ea la- aSg •2a= alii; ^2|a _^ 1^ a.a ffill ftil!^ Ill fill: i|p;o ||. - |a 1 §sil i g^STl? 8aa.a2£ 1 Is ail ^ l.g t^l "■a .5 is? ''- g-asg.§ag li)"^ z ^ cp "£"S "f"" tf -5 .2 M hS "I ^ ^ ^ s « -^ o < ^ ^ ^^ 12. 1 ri " ot d ^ CO -* lO to t~" CC 05 :r: "• "i" CO j^ Q, en -;_: "^ r- •" ■" '" •^ ^ o c. CS c ^ 1 RECOMMENDATIONS OF COMMITTEL ON HEALTH AND ME Die \J . RELIEF. Ill ■S3«a il 1 g W.I '3 ^1 g s i g'S'O ' •? . a = Sat: 1 ill if !• Ill -It £11 fjl 1 db .H-add S d ;■§ s§ gii.g .ae|§ .§ o.t;,o ^ I 1 2 1 III s§ a E m 20 S HEHfc, Jh g;S 2 ^ r^ m t^ 2 m 22 ra3 i S .s 1 ias ^1. •o"^ ' 1 .-1 1 1,3 § ? 6 si : : ^ ■ ■§ .g : \ i ■. ■ g .2 = • c 1 3 Igii c ill ill jig ! ll" i s 11 I 1 2 M 1z;e^ ^ Z>|2; 2 22 Z ^ >^ ^« 2 2 2 II : : § ; g . S ■£ : > :J "^ • 3 O .g-9 2 % ' '■■ s ai d c i 1 ^ § :Se ill ^ N Sm n 213 2 !g M so 2 222 2 22 2 >, ^ 2 2 2 21S ^■3 ■ ; C : 1 1 i 1 g1 i 1 Hi 1 S OT & 1 1 '&. Ig 1-^ C ; : < 2 « gH N BH^- >^ 22 2 >. >H 2 2 1 2P i Mi! il • i -B to ■a m . ■ 5| ^° " 1 o.|« :| m" : H s ■g|» g a ^Irt C. Js '^'^j d c ■3! ra (.-so s.'sao Q c i c ^ , 1 ^ 1 1 § c s 5 Sm r S-g; g; S; A 20 2 222 2 22 2 2 ;^ m 2 2 2 22 : ; t^ ■ : '^ ^ ; h| ' ' b • ■ ■ rt g : st U ! : i 1 >, 1 1 JiSi ! c 3 3 = c " 13 ■= a 1 ^ d i a°"" = -^m q g^ >H Iz; 2 2222 -H ^" 2 2 2 22 ! g 1 1 i I j- g ■Is . ill! uluth, So. Atlantic R quotte, Mi( 1 1 1 1 ^r 1 s| 1 1 II 1 11 : ""1 1/ : ^a 5 3 : a ; as 5,- R I ^ ":^;zi S2; ^; 2 m 00 S & 2 (h <3 >: 2 m 22 j ■«3 !» ^0 : ^ 1 ,Q |k '■S \ 1 >^ ■0 ; o 3 y. 1 1 • tf ■ (3 s ;^ .3 -§§ '"si ■ S « M >. ss„- .':t3 : 3 -S £ ^ !- °' 3S = =22 5 is d S^c J. J. € c g ^ ^ ^ « 1 ■g^ II e - -iSW 32 >^2 ra (§2 2 222 2 22 g 2 2 i^ 1 ^ 22 |8 11. a 1 • * & ^ ■ ■■■■S'Si Is si Is 1 |i c§ ilillilfa^ |J| H Ijlj^ J j|l| j llllii {fiil:!}! iip ^ 3 . 1 11 i| Z fit: II ! Illl ll i c <1! c •ii -, g^ ■0 3 .11 ' 1.3 III laS bo ^ Sag a Eia ^- i;S:. ^ a W-^ M .2^5-^, i2j ■< '■^ J R ■§ > i= i^p: J n I .. t-' 2 £ j: - s t S g s S S K g s %. S ^ S 1 47 48 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. i part- Btion vice, 21-35 b in- ^ §1= °s° 1 1 2 <; o I 'S .,g|| if i. t>. 1 Pi 1 ^:8 1 fiiffi i" .11 . , 1 ilh -: i ■ ll ft i §g IS i~-| z z z ra o S ^ z k" z z z »«^^ |S < z z z zz •a ? g ■3 ■Sg a° >i 8| 1 §11 — ^- s •a §■« e as v .a . c3 CQ^ ^ g l^- fe ° .st-:s t^l §8=. ■ft w"§ ^ ^ ^ ■g 1 s-g i S ilnS S g ^ J ^ J 1 i i S-KK O sz z z z z &: s'' P H Ph >h >h Z z >■ z > z o zz 1 «l g jia ._^ ffl •2 ■e f- 03 TH ■- fl © g ^ gS ! II « a ft g o ■a 1 •3°|g-| II g a . "1 Ph-*-^ (^ 2 s- S -w ^ I>^ o d o °< £B.§7ft £■§ S J dig. s.i c Q c c c 1' o o 'J'C^ Z Z Z n S o S o !h :s z z z !« Z z z z zz 1 ►J 11° ■ 13 a III 1 ft '^ a .s 11 "i^ Pi "^ OT i2 ■d s5 g g ig«l S c 1 1 tII c •^ h a c 1! 'is i o ^ o « c t" a f^ ScfO z >< z 1 z S s'^'" z f=H ^ t>H ;^ I?; >H !>i >^ z z z p 0(i< 1 III 111 1 So iill 1 ill II 1 a? i |«.|si £«£o 1 K,-l 5 < - m ''go 1 § 1 1 fill .a .. is as 1 li O-S a'c; . 1 1 3, S3. a 2 > 6 i o S-SK Q ISZ >< z m So S o H S Z >H O t" >■ z z hH ZO •si |p5 5 g PI HI 1 1 la c *^ la t si i! aa 5 4=1 S ft •la c «ia.sag a 2; ScqW Q sz z z m' ""z o S o >■ 6 ??; |>< Z >< >- z z z Zo 1 S M 1 jj A 1 ^ i s T3 "^ § !>.ir E-i 9 fl^ c c i° a c c > la §a c . d 1 SS2i O ^z z z B s z z J Z Z Z Z Z Z >H z z 1 z ZZ 1 H .^ i ^ J c ti. C *-• & 1-5 l-H . o s '^ fi III 1 |.a 0-T3 ft 1 1 "^-r . ^;l §5« « 111 s Eg .a' a gag "^■S" 41 g ^ .S| 1 s d i i o as " 1 3 S^ sz o .-z z z z S H S e Z f=, Z l>H Z Z !« z z z z zz 1 1| ll . 1 1 i 'i ^ Isl pi > 1 E £ E 1^ 1 1 S li 1 i II ft £o sa oln £■"•« £S£|Sga?.p i^ll II Nilliii gl if if •|fi |i <0 ly 1 II spj |J;jl|.|| •i||||||a|fe| ^ o^ a.-. >■ ^ ""^ ° 1 i iffl■^■ « a& .^1 .g 1' ll 1 oil IJ i "J- -§1.1 |si ll 1 j3 :;■« " ? a o -SSSa'aS'' g£asa.5,sg <: a S 1 .g c c- z o g ■o a Jl ^J§g 5: ■ Isl |ga lis a g-c "^ 2 cd 4 j ^ 1 o Jjll M Z O •S 1^ p. 3 If If a ■5 • B.SSi •a g -ffill IS ti flJ § ^ •'■« .§«§ .||.s .al'l 2&2 2ft2u ■So 2 = .id C s ^ III ■%' - § § So. |i3-gg _?• .* g a 8 i c fM O O M < ? Z « g S 1-1 cj A Z Z GOO g a J, I'i c 1 Ha 1 a \ 1 1. II i 1 c Z c 1.1 . sis •a g o o W S 1 «; ^- ^ ii ?; e ■ fi z >^ o o fe 1 i ^ •S -5 1 •! S s q . si 05 03 3 g.a I 31- is 1 1 I 1 g 1 f g 6 ft p. Ic 5 1 ^ g -g Si 1 I 1 I 1 li 1 ir o s m <) < o « fe= i3 tH z « M c a , — o +J S 1 Is ^ft i 1 "S a-3 o 'A a g — o !i1 ft fe 1 1 ft .g 1 t -c ¥ -S O 1 1" p"*" S S F5 o 3 fi z ll n 1 i T § a 2 = 1 1 i a 1 i a c 3^ o 1' ~ "o g ft ft .a g ^ ^ ft o O m a; , < 2, .,i S So R z z « 1 ■' 1 jil 12 ^ T^ 'o o cs P5 a a a d •O o 42 1- 22 c 1= C 1 J3 I a t^ c c « o o 7^ c g 1 s 1 § g 1 O c z 1 ft '^ 1 . .g„- .£? .£>«>?.2gS"S dj'^g cb^gg III atj !.§• ll i.ai|ip.^'i i Ill's 11 1'lf 'Z-Vz |1 s'Sf-s 1,1 aj §2 1?.° g° &0 be ag.a li 1 ^ c 1 £ 1 ..i ll : 1 i| s5 1 ;2 .111 = • .1 g'S. ii "o g if°l It ^5 i 1 "1 i 2 1 1= eoees |e ^ M Z Z P p w _, , -T*, H ^s e e ■^* !! •-' c< S' ■3' lO »~ ^ -- •" 1 50 EECOMMENDATIONS OF COMMITTEE OW HEALTH AND MEDICAL BELIEF. . ■o i iS 1 o o A s ,g Ti m PI ■« ss a ,d 1. 1 i g, g §-3, 3 ■ 1 II s a a o f^ < 'A 3 g S K^ ►^ >^ >^ B % a '■■Mh \ s ■a <" g g 1 1 c 1 g 1 c 1 It 1 \B 1*^ ■3rt 1'' O St tj i 1 ijll i d i. 1 . S 1- st 5 o D m 1 Z O 6 A >< >* o ;<; 3 K 1 ggS :| ■a • Z s •1 ;= § 1 ■o^ 1 f. 1 1 ^"i 'Is 1 ^ 1 ■„ S s 3= • • 63 ■ ii if ^3 ;a 11 fl u S a ; s £ ;-< ca g S S ^^ o . p, i» i» o .o 1 ■¥^.^ i ^ ■S ; 1 a ^'Ka g •a i 3 1 i i 1 a 1 :§f as 1 , 1 ■3.2 ^ S g-rt i ^ ■S^t' o :|n £S 1 a 11 p ■a ■« I S« S g ■1 g & S o S' :S 1 H o 2; :h „ ;3 a s z hj >H Z aj ;0 •3 1 4 :3 ^ a .' g « ^ ^'i?- tJ ■ ^ ■."& a s ^ 'O m . •A 5 " c3 S*^ .g .c (B ■p. a . 2 "is 3 oi ? IL ^ ^ % 1 Is i ?| a fl g 3 (- !-■ c5 ■g giS -e " 1 i^ 1 I % i'^'i i ° .° c ii 1 a R o ^ < ;iS w S So o >- z Eh O A •o ■» ■- aasi •■ ■g gs •g-g & : ;! l-'l \ ;s a a ^rQ ■a bon c 1 1 P 05 O 3 < Ml 1 * \ : I i i 2 2 2 fea'-S'S a .a a ■ fsll o n r) 1 1 ■ § E 1 :j ; ;\ 11 a a «) ■' •g-gt= : S-laa ■<1 3 . 3« 1 j| ;3 i i :^ 1 '2 : i ; ft ■ Q . 1 % h alll ill a ■a Ii. : " ■^ < i ;3 s ■;. N s : o b" ,z z O O T 1- is 3 g - a ■ Oh ■ ^ III ll6 : i : at_ ; „ 2 g«| . aiiliBIJiil iiiffii 11 11 11 as iA £ 11° |i1 §i ; 1 111 iil If 1 j tell! till 1 igS Sfg 2^ ftf ,^ IlllBllillll 1 a .a i i S" d2Sp.«p,oS-ss«QS^ o S" £§■?■§ fiSaggg "* "* "* "• ^ ' RECOMMENDATIONS OP COMMITTEE ON HEALTH AND MEDICAL BELIEF. 51 it ^ I « - s oca IS. -is i I I ^. till ; p. o o 1 Z Z gg If! a „«g I o Sig'-g 9 S(^g 3 §112 !■ i I ° R hj o n S z la 1-2 § ^ S Hi o P P <1 Z S ^s P" lis sa 13 e ;i till il:l si Hill IHii P ni$i |ll l|t|ltilBpi!i:aill sS Sj's's'.ilo j=£g fe^'fei' o,-2 §fe "S ftr i'^ c §f i&S ^i ai 52 RECOMMENDATIONS OV COMMITTEE ON HEAI^TH AND MEDICAL, RELIEF. rt«^ §3^ 30? |3S i ^^ ;^ n Sg iz; z 6 -i I aj »: I J I I ss z z z zz S3 |« P5M 1-9 |§5 ?J ^' -§ 1 as §a z z m g HH >^>H < ><« >< i.gs 2Z Z 2; m « o z; z z zz ftPn szl .gg-gsi p-i-p ZZ>^'">^>^ Z >^Zt> ZZ « ^ ll'= 3z z z m S fr^ a §B as ZZZ Z^ m">Jzl°ZZ o a.| S-gg 1,. |-e 2^^ ftc3 S '-C as ■SS lit 2 m as oi-S ^ g fl t 3S---3 g-^ ■3 a; ^^B§-3fe-Sftg&a-Sftp.-s8at |i=. «|s ill's |2iis«.-.^'f-.l|=-.^°'slt-| |g|illi~ |.g^ £|l^l'is..a.§||-s|gig^Si-gs|a-Sg»^;|s."|| s £ g I Ig g^ 5 g| S S|^a al ^•S I'll a ai gll-il s ili|| RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAI. KELIEP' 53 gs 'i S ^ p g 1 i .a" 1 1 fe^ is- 8.2 I! •5 .5' a i .s i 3s ■§■= |2 l§ S i .s ^ s 1 S|T5 fc. cfSw fi f3 1 1 1 n S 0" Z Z Z Z >H z z !>! w z "-^ Z Z fc. B^- S" ' i i -5 a J b V. \ 1^ f= o~ as .J3 1 s 1 g 1 a 8 i If ; II i II i 2^ a •S& alii ,-000. s J3 8 j 1 ^ w "-§m ft 'g Z l« •A n p « z z >^ ^^ z 1^ i^ ^ « > z z z z T) o g- s ■=1 : g • = S. o ; ^ ;. 1 1 s ; s ■3| ^ {Jii " 1* 5i ^ 3 II si : ll i ill i iiti Q 3?§n o a ?; ^^ §, n p < S H z z z z z i>^ p-t z z Z 6- z z a- S p j J H ■ 5 ' a CO « • £ •a",' ^ d ; t= ^s ►Jo : 2 Jn t- .O ^ §1 Hg- ■6 2 £ g oR d ■ o 332; P - z Z z 1 z z z z 2 z Z 2 2 z z z 2 Z « I z So- ; C .o : a| ■ P 1 ^ 1 1 ■ -2 ■ a. p •i Ht-- ■ tifin ' * ^ S dt fr.' 3 t.-P !i ^ £ ^ 1 = 1 n 1 o ujgW P S :! 1 Z 1 Z 0" N c 2 z ^ > 2 z z z 2 2; fi 2 z l«^ G 1 ; i SP =«' 13 .0 & ■g J K^ M a g ! ; P-, gB^ S S ^ • ^ s S5 s '■■S 1 .a 2 * >> T3 S i j II E^ :'S> w-E -. ; a T • i .22 £c 2 3mo f2J§ 7 c 3 S-a o p"? z ? Z 1 z z 2 2 2 < S Z 2 ; 2 5 Z . i>^ <; 2 5 Z « 2 ; z t^ o iT c" -J fe| ■a 3 : if^ ll wo ;i 1 ■ i 1 1 , 1 1 ; ^ ■ I 1 2 •• ll ; g o ;| it E "o" • i i J 5 1 1 : : ! 1 : a 3 8 5 -0' 1 i 3 >> il 3 ; 3s 3 1 %t • 1 3 s c g=^-a « s ?i ^ z ^ M ^ 2 5 6 Z > ■H Z 2 ->^ < > H Z P*" C 3 t-i i i J |l §2 1 1 = 1 1 h 1 11 ■ca so Is fe a 1' ■3. 1 ■ i 1^ : ill si if 9| J il ' ■£■- 3 sa-3 - •§§!./. fill la' 3 5 fc 3 aa J a'g-H. S ^'"3. - 3 i-:.2 3 ll 1 --.- a| .s| §a ^ ' n |l ;i|l il ^ ■sis ll -■ ; ills all ::, SS . 1 ■§§ sii-iii .3 1 \ ¥ 1 aS III, -2 .ri Z P C- " 3 "a" H ;:! -^ ^ . 5 ^ -^ " 't = p, f 5 -^ 2 p: f= s ?; - M •i- CJ / -i ; 3' i 2 , 5 3 3 i ; 2 5 ^ ^ ; i ' -'5 ? '■i s Ci 3 5 54 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. ■3 • |.| a pi 1 -5 1 1 ^s 1 o'L c g; 2 By company surgeons. No data. Operating department. 26-45; all departments. Train service. Yes. 1 g M la !z JH >■ !> " 1 g 2 2 ^i ■: §-i 1 EC 1 E lit •si a"i| g a 11 5. > i 2 1 _rt'a >^ >■ I 1| ll |-| - If c 1 |8 : ■~S : £"22 g SP i .a-- 1 '^■'^ i w| 'p. ^ ffi (S N 1 1 > 1 c t q 9 c c g >: c pi 1 1 c 55 1 1 1 2 1 c 1 2 1 C 1 ll si" |« ooio 'A 1 1 ^! m g c 1 1 1 H t>. c ■aa g i till .i'Jlog S e 5! 1 1 1 2 1 ll S'.H 2 ^ 1 1 1 1 S 1 :^& ill 2;3 grto 1-^ Tf 1 • 5 .2 g ° 1 i ^ • -3 >■.» ■a 5| a c !3 c 1 c 3 < 1 1 a _ 1 1 £ 1 ■ > >: 1 a ag > .p d || 1 1 S :| a :3 ^ c ■ c*, a ;.o II ii il ll IS 2;j 5 .■so : w ■■ 'S^ ' -^ d 1 1 c 2; < ^ ^ 1 c s a 1 a 1 ill S. f 1 S S s >■ 1 1 1 c •3 c 2 IS c 1 c I 2 s : 5 ^ i 1 r"^ 1 c 1 c c C 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 c c 2 c 2 1 Is ii 3. i .^ a a-; 1^ 1 1. s s ^ 1 ^ s g .0 ^ ■|ii 1 S|| i ^ i5 ti c 1 2 ■0 1> £ PC 3 B .1 1/! ale e ^1 ^^ is ii •c i 1 i £ S c a 1 g i 1 ^ III ;p.-g £ i - % I 1 ^ § ■ ^ efl 11 Si I'e -■a 5 1} a 1 1 1 ^ w = til III iJ £.ag 11 ll 1 c S .1 .1 ? >. *p ale n E c c as ll fj 1 ^ « 1 1 1 g^ £ ill '11 1 C3 C .2 •£ i .1 1 1 111 g..£ 1 1 1 i ■II 1 1 c l E .1 1 i: a a a >. .a ll 11 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 55 MS . s^ s ■.i z c 1 k3 §3 |5 P 1 1 5; si 1.1 ag 1 a 2' (^ 1 >fl .-S 1 S ■£ a 3S 2 -S'S 3. A 6 1 d i d — i ^ ^. si ^ ^- 1 p"s!l 1 !a 1 z o" z z a";! z Z Z z (H Z >< z z z '3 ; ; I : ■ o i» ►-5 ll ^ 2 " a t d : m (5 . §! '■§ .§ .§ a £' ^ if =^1 p-6 1 1 o a s t 2 S o 1 a 8 ll £ c £ ^ t^ gM. Q ^2 ^ J5 p m Eh Z H >< !x Z z z z ^^ ^ ^ Z J z z z - _ ^ w fC • ■ JH i if If ■a ° A'S'i^ » 2 :g a :-s o if 1 a| 1 II i s EfS .2 . 1 tg ss i2 8 a 1 111} 1 a §1 i n'ft < e; 1 S o'" S S H S >« z z r^ '^ z >< Z P Z Ch 1 1^ : ; S t. 1 1 J li 11 al -1 .ll 1 c % 3 2 ; 2 g iscB « s^s >^ a m > o Z O Z Z Z z z Z V* >H fe ;£ z Z Z fc :•: d"-: P li 1^1 I ^ If ; § Io ii M J2 5 -2 "ci :« wS 1 l"-'!"!!!^!- ^i* 1 s|' fefH •■& .•£ 1 B Sg£g'g'g.g^.go-| il •G (= S :a i^o j3 '^a_£:3f3op.o5;S^a ■a "a §'qj §■" ° ;l .-S^d s d d ^ =-Sl^g£aile.2 , ^ S c ^-0 3 d s i > Ss m S :H Sg; >» ^ Z Z ^ >^ z t>^ >< Z >< z P3' P Z O - N 1 :g a a j S2 i « 1 ■a •a ■| a" If 1 III 3 1 §•§•5. i II 1 ^si ■9| = 9£l& 1 ^'^ ^ 3 o tn I a < Z z z ^ z; ph io .2« ■i 1 Is p IS. "-§ 1.3 ^Q c dm' ii &1 1 5: 1 |.i 1 d^ p. a'g'E c i ii a-g 1 (S iuiH H oc'i? z; z; m°' p ^" ^ Z z z z z z J ■a g ■ S S c III >* ? ^a ^4a gS -S -Si g> § 1=.. §■§ gg g iw S-s Sol P g il ii 1 I 1 ■£ -II C| ^ % it 1^ II :| 1 ^,;^ 1 II ■■ill t!llj°' liil iJilir S^zis |,„z;Sa=a (2-s ' 1 £ t § i 1 ^ 1 1 •o c 1 1 1 E 1 ^ a 1 1 E J i '^ 1 1 u PM 1 is p. s' at it 1 Ji 1 •a.Sf g III -o E c si "p.£ ^ 2 t! .IS I'i 6| ll 1 Is! < il i 'il ^ tt! il 1 111! 1 EECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 57 J. t I 1 a ^ s Is 1 1 1 a c E 1 III i 'a 1 ' 1" ^ p* 2"''3-2 P 'q, oj cJ ■ f^ vS 5 .§pa "§« 5 g i" g g lis o d "S 2; o o m ai W !S ^ o cj P 2; 2: a S *J ; y- ^ 1 ' is J w S 6 i'p. a 1 •3 "3 E : § '^ 1 ;£ : g t it C3 i i ic • 3 k 1 : a \ . '^ "as: '■ P. » S " ■§ ■ o Q S -a o ;^X 3 >j o ; " « O :o 2; o;; s s ij s P 1 S 1 c3 ^ a, , o • o a :B 1 "a * 1 ga° a Eh ■.a M M £ 3 E S a a ^- :|f : o 1 1 & 1 i a ■ffl "ra ^ m aj III ■ t.a i, p- p. & 's -§ „ 3 ■^ f^ S O OOct w :<) ^ S' S S o o O iS 1 o 1 1 a S: ' >; ^ a 1 ro £ 1 a rtS 3 i i ^ * 1 G. ■a i ic *i i is s S ^ ^ c3 i " s-a £ R : : ^ • p. ft .a ' o o .^ 3 S S R P 1 /5 i ^ '^' o Sj O s. g Q s £.S .2 ■^ p ' : § in ■9i 1 g i g E j| !■ B aP. i 1 s 1 1 J 1 I \l\ ^ c a c : ^ tK < E-a^^i:; 'S^joP 1 2; o o g 13 a ^ »- <» :.i =, a m 3 -3 ;| 1 a •a |« o 1 c a : '^ ■3» .g . -| II is :td _ \ 1 u S g a ^ ^ 111 OOP 1 1 1^ 1 - ■a 2 a • i-p -3 a -a s & : %■ 52 3 i 3s :•§ a » 7 al i^» 1 s a § 1*. S" a a a 11 5 t c d M c ? ill £ 1 1 1 i 1 s fe 5 o p > 1 3 o X 5^ ' : i c ,5 g| 11 i o if it /Si"? g5 i£.2|^gSgl?S| gja=|l-2||"a f!§ "a iilii^|iiii| i|il||pP s.|| li jilljli?ii|hfi||||||5 l|g' 1^ a =^ a na^ a~.g ^-g-ciaTj StS.S P.« a PI "-ga 'S •S';: s £>■£? ^? ?= ^•S'l.q £ g 2 o gas ,^| al g-^i^ P S J^-x'£ ^'S -1 g |r= 5g-g- |a Sl &g pSfa 1 -■ "■ " " '"■ <= I" " c- c =: £ S 3 5g RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. o 3 1 «■ ■a ^ K _^ i cd t; o t-^g 1 i ! ! 1 1 ,: III '" S C3 ^ in 1 "' oo o' oo_3o o ^ ■3 §.& f^ O to < fd ^ o s S hJ 5 ^ |Zi o J d i 1 a -p ■a 1 ■2 1" *> .a rt a 1 p. s j „ /2' S 1 «■ f i OJ "d o ft ^ 5 ^ Ti c 3 a X 1 p 1 1 2 3-2 i . II 13 ^^ O s 1 -S <« Eh W o s g So li o 31 Is •§ o ■^ •Sp-I 1 i c4 111 m . +^ P5 1 I 1 £ ■a > III III! o ft 11 c ? p I p 1 i ft ■Si 3 •i fl-g Q '"• o :i o d o sa ■2 |i.O o ■< oSSiS ^►^bn s; ^ w o e P|i 1 ^ ; i§ii 1.: ■ 1 ? 1 lit! flS ,, a ■ 1 ■3 ^ o o o^ ^ ta o s ^ "^ p 1 K II 1 3 w c 3 1 ilal ir o ^ c l| c 1 3 S f^O o 5 ■""'' W^RS SKoR Z Z K w wo b' RO^ fl o ft QJ«> OT o J ^ s - +j ■tj "^ & • X J 6 s tf L 1 li ' g p. ■3 0^-1 S § d £ o BE II a |8 °a«^ 1 § ftl '1 1 1 i" 1 1 i 1 i 1 ^3 t: ^ fHC a m << ", ^O^Sm SooO ;z; ll O s ft !i § ! IP^ III iti^i l^i iP-iliiiii iSiPllEll ill 1 % f 1 1 0-2 p "(J ^3 K 1 > c "S" ■■=■; 1 |3il||o'oplgo-a.||.g»|-g'".-° 11 H fi!l{lifl|il!i!iW4li ^ iiiiii|biiipirriiiiiii to t. a g i 1 1 x: li ^ ci ro ^ ift CO r~' 00 ai o ^ c^" CO -r •- H ^ 1 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEl'. 59 "S rt w c t; S "^ d ol g O it 2w 1 J= o •Is "3 "■| a fl §|« .■§ wi S a| "ft 13 ^ |Ih i^l a"^? 5 ° £ £ S la o odd d d g d s c § go O 2 Z 1? ^ Z S fc< Z Z Z Z Z Z z Z IH z z z Z Z Z II id g" M 1 1 1 1 at S § a go E3 £ w §Hss m jo .:W d sj d 6 a l-sa -J* C ® o .o d d g d o Q- d c ill n S^H fi ?: ^ ^ ?; Z m o ^_ tH !h >H Z Z z z >- Z Z Z z z z P. op3 . S :8 1 £ g s III a '■§ 1 "^ a , 1 s a s 1- i c c 1 =5 ■a g [ w" nSH g z !« z m s H Z z t-l >< z ;S ;? z s z 1 1. B .g" ^t a 1 1 IW.rt M 1^ : a 1 ^ §2 • "^ Efl a a t^T? T3 :|| i»l 1 0S 1 1 1 o '^ c: 5 i^§-aH^;W^ odd d o a-si T O Q Q d d i d d ^ ■ ^ § 1 § o c-rSco n s z z z z z o M z z z Z Z z Z Z z z z Z m Z ll ;| in ■ tll iasga >>§ g a =3| •§CJ :1 s 15 i>,a ,s„'S a S !t| £ si :l D O i c al*i^ 8 " g 9 •alij M a n |-§a 1 §"5 lis aS Ifijf Ssalio w W c3 Ilio s lis"' slla o 1 1 i i 1 ^ CJ "-SB z ;>< Z « K o S Z H Z Z tH M Z >^ z ^''l z 1 z 1 ■3 ■ rt g- 1 ^ a a : S n OS r^ s Is ■1 :| Is ^ 1 >> i 1 ll :s Kg ■o'l ■a "^ .a .s g 1 a •Sw CO : o ^•w d d d t>,^ S*^ d d d a ft s g d s ^ o C g g g o §SH R ^ Z Z Z ra o E=l Z z z S ^ z z Z >H z H ;3 iz; iz; ?; o*^ ; • a «l il to 1 a ;.| 1 C5 g 1 1 1 If .1 .g fees?: S3 • S t;>J d o d d *^ a-i d s s g d d J^ « i g § § c=< §tJP1 fi 5 Z !x Z Z S o z H z z !x >^ z z z z >^ iz; z z z rt fl" a «>; 1^ a 14 '^^~ o a « "1 el's >5 .1 a fl' ae a ■ a .g a" £ g i 1 § 1 f £ S-;? Q w Z Z Z Z B 5 s W >H z Z Z z Z !^ z ll !^ z z z ii ll 'i '■ a : 1 : i ■" 3-1 ;i| ; £ a 1 1 1 i III 1 1 ■^1 a° si piisiiig^sil: |-sz=ss|'oSw?la. pt SI • gll III i.£§ga5aa ils -ii Slip's 3= i-i ii §is-i& til ffEsI a". lilil ilSf iPllii i| .92 II a.g 1^^ s^is-^ gss| .a|.g |o^|g 3|"'SaoS»c |2£|adNa£|^|o| |fe^3.2-s_gg|g|_§8.g.g "&?:oS'.g£S,gi'o«§5fl Hal ^11 mil in -"llllillt iplilisi ^^"IJ « ^ ,2 w ■s; w « ,2? -^ H -^ &: ?3 fi - " " " " '^ " " : c Z Z .^ >; 1 z — go c z iS c z z lis S'"z k i .2 El a „ ■ i 1 :- .2 s = g 1 >i c z 1 ^ c z >^ 1 z Z z z z Z 2 z >< z z z p. ■Si t>.S Hi a , K 1 c :! c z c z g .as? Sg| E °la s 1 Z z z z Z z z z ■5 z p z - •Hi 11 S ■1 ^ 1 °=a 1 Is B ?: z 1 z z 1 1 E- z i .3 1 1 z z c z c z c z ^ z ■0 sa i N z z 1 z 1 Z Is R 1 P s 1 1 z z z c z .g if n. c s z c z z z c z c z c z 1 z z z p. § ' I z z z i 1 ^1 s §3 - Eg t ^1 W P 3 : 1 z z z i 1 1 1 1 1 i 1 E= z C ill c S z z z c z ^ IS 1 ■ i >l 1 §■3 If ^ 3 ^ 1 z .2 Z z 1 z 11 1" 1 1" 1 E 1 1 > J . 1 3 §1 •11 0* It J llll .s-sa > T3 j^ B 1 -111 •fa 1 S J M - m ■SSp£ All offltia .|E2g 0= E il 1 ll 1 in IN- . !P 4i •= ill He col; < llll -■oWgl sill 1< ■2II ■■3 si 2 = III III i > 11 a 1 ill p •i| 1 la i ia i g 'ffa .i -111; a g ■1 1 f>._c ll OS'S 15 c -1 ll al slat- RECOMMENDATIONS OF COMMITTEE ON HEALTH .AND MEDICAL BELIEF. 61 § ^- 1 § 1 a i g .3 -5 .0 0^ ci |f •3 "5 »; •S -. . 1 1 it d g ^111 M a ca o ^ a o S 2 O}^ =? ■S a; 11^ Ui .5 -a .3 « ■§ -9 11 1 a— ^ 1 2 ^i-z'Sz, a 3-= = ag ssess ^WH S.oi2i3.dcid >>oS ->-. add d d £2g? S d s m CO-3W O 3Z Z 2; « 55 H s o is 2; Z 2; H >^ >H 2 >< 2 'S <: t: " go '■,';>< ; ji a a : •2» ^ |2 1 1 "^ i 1^ H ca~ 1 1 1 a"^ §a i 1 i "S I 1 J2 I^ : c ^ : ■n.S 1 g-o I :5« J :2 ■ a : ift "'I : n 1 g .3 -a as S ; s ? 1 S^ S 11 J Is c i CO a-SK O SS 5^2 IS IS H s B Z IS !S W t. !5 Z Z ^ 2 M 2 2 1 ^i : : a" : d 1 2 ' ' -^ X ■ 1 1 a p"_ M 15 i fl.2 • g. .2« n' lie =1 : 3J la 1 = s 2 ■i'H 2 ^ a/ a- go£ «i ;" ^^ : d d o d S P, ^>, a 6 6 o d 3 d o ^ So £i B O) gSm fi '32 ^ ^ g; o o s o g; 2; Z Is is 2; >< 2 2 2 2 S 2 . . ■ ■ +i ' ^ irt A Spig i| j 1 1 : 1 as ■S "o : ll ? ■ d !i a ^'sS J ' o u:j : ci S d d ^ S.-a d 8 § d o g 00 00 S./iM R ^^ >^ Z ^ S o f5 H IS IS |J Sh 2; Z 2 2 >< 2 2 2 2 a."" : : ^ ; 2 3 ; : '^ S ^ f^3 :§.'■-" : ■ ^3 ! i a M^ ■'i "3 ■ : J p- c ■J m o •■ss S li "1 i §8 ^-^c- : ■! 1 3 d S c f -^3 " 1 rJ:, .1 i a » c S i ! CO S"«-W O S^; >H 2; Is S o H Is C=i f- >i 2; 2; 2 2 > 2 2 2 2 1 c< ■o o ■ 1 a B 1 E ■J Is 2; li o E^'^ o f 2; g ' Is 2 2 t> 2 6- 2 c^ « 2 1 Mil 1 '^* : i li 1 s II :l >a : : 1 i - 3 ■^ ■ i - c £.2 ■5 ^'b ■ ■ ^ ■ "3 ■« ©"^ ■ T : " |j ■•■§ Ph'-J : i 1 i a a : c. si ■ 1 1 J 5 IgS ^Sd d Sf d o 5. 'S 7 2 £ d d ■ i § d S S : 5I i § '2 a g3„-W O ^2; (h Is 2 S H s S 2; 2; 6 ^ >- 2 2; > - >^ ^ 5 2 2 R 2 g ■cj !i £ a 1. a 3 •2.3 Il 1 IK tl ss! Jl !l iSiS iiji || £ Pi 11^ 11 §11 ^™ = n© y fl-r ° Sj - C3i2 ■ 3 SB ■■ 5^532 = 2!^ Is 2 a 3 il II ta. • 1 s fipp.|i III 3.glill1l III |aps- 1 g- ^^ ;s p B ^ s a a i; . a""-? ^"gj f ^ -S" c J g ^ ^ ^ ^ fH « ^^ -i 1- CO D - i I 3 S 2 3 t 3 ; 5 !L? ^ E s e ^ i 5 s i % i ? : ( 62 RECOMMENDATIONS QE COMMITTEE ON HEALTH AND MEDICAL RELIEF. 3g S: Hospital association. Dr. Bacon Saimders, Fort Worth, Tex. No. No. 1 By company surgeons, at division points. 35 to 40 per cent. Operating and mechan- ical departments. Nn. Z 2; 2 >: 1 2; 1 > k a 1 lis 1 1^ 1 1 m c 1 c g| 1 1 i 1 RE : : •§ : i g ^ ■ :i 'i^ : : S " »" : il SI; 5W £■" :5 ° ll 1 ^ o a |» So •si 1 1 1 1 >^ z; z 1 I £ Z IS ^' : : i : \ \ ^ ; •w 3 ■ ? :s 2; 1 1 1 c a s" .1 la \ sa § 111 S e a E 2 c 2 1 1 1 c Z 1 1 2 1 z Z o" : a* r^ : :'s i : ;l -^^1 3W fi. 2 o c 5 ;z c 1 1 1 S "^ >. c R C .1 1 1 p. ag >>— is C fe 2 S -^ 1 z c 2 2 s >" Z a a m" Z Z ■ftO •|z §•«- g'1,3 t 1 1 c 1 1 1 >, c ,1 8^ 2 1 1 ;! 1 z; z; 2; c 2 z 1 2 1 Z 1 : ■ i : :g =3 : •1 6 • • ■'1 P 1 il ^|i it ^^i 1 1 Z Z C 1 if •aa :l c 2 [A 1 >H 2 c 2 c 1 2 2 1 z 2 z [ z S g 3tii iti J ii ^ i ii ^li : S. « g" : 1 (^ g 1 1 m 2 J -a a 1 M 1 iSi .S •§ -2 n §2 c o S 2 .5 ft'-' as 3 c 2 Z z < S > 1 • ll z a-g a.g ■"* a II 5 sill 2 I- il 1^ li 1- : g g • if 1 1 is ajl p fill i 1? 1 a 1 '. 5 C 1 i 1 « rt •.- la "- Si|: li f III m slips' N ■ a 2 "a- 3 p 1 3 .^ J 1 1 j 3 e 8 3 .a 5 S ill " ■ »sa 3 ? 1 i a % 1 c si 1 3 E >■.■;: .a": 3 ^ ■2 .a" 3 8 'a c :| ° 3 ^ - B.S -^ 111! - P !al 1. as if s ft RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL, RELIEF. 63 i - o a S a •^, "S3§, w ^ "m^ Q? "a w |g ■- P-, ■o 's- z ■ n t>,d "5,^ .^ tf d'^"^ ■ *« S si 1 -sl^s 1 1! 1 J 1 E PP II a g a a o o log p a Q fe a -z > ■S-2 : : rt ^ O ei J (3 ; C ; -■^ ■ ; ;S ill: m ' 1 i 1^ : : 1 oi p< a 1. 1 ^ it C 1 1 1 o 1 aT=-S tt M o ; fa CO :w c^ c-i : ^ o o O J'. z M. : : C n J t^ 1 s t ■ ^ 6 o : '■ B ai 1 i' 1 i p. a ;-sa a a g- c>. 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Exhibit D. The committee found a great lack of uniformity within the several States and among the various rail- roads on the subject of sanitary regulations, and as a result of this lack of uniformity there was created much confusion and many obstacles to successful operation. In many adjoining States conflicting regulations made it difficult to carry out instructions. This matter was brought to the attention of the State and Territorial health officers, and the committee was asked to submit a draft to them. The following code is an expression of the work of the committee. This has been approved by the Director General as rec m- mendatory practice for the railroads, and has been approved by Surg. Gen. Blue of the United States Public Health Service. See letter next attached. Treasury Department, Bureau oe the Public Health Service, Washington, Dccenihei' 5. 1919. Dr. D. Z. DuNOTT, M. D., United Railroad Administration, Washington, D. C. My Dear Doctor Dunott: I have examined the proposed rail- way sanitary code, and I desii'e to congratulate the committee on the excellent provisions contained therein. I have no hesitancy in giving my approval in view of the fact that they conform to the existing interstate quarantine regulations, but this approval is contingent upon futme modification of yom- code to conform to contemplated changes in the interstate quaran- tine regulations. Respectfully, (Signed) Rupert Blue, Surgeon General. EAILWAY SANITARY CODE. REGULATIONS FOB THE MAINTENANCE OF SANI- TARY CONDITIONS IN RAILWAY CARS, STATIONS, CONSTRUCTION CAMPS, SHOPS, AND OFFICES. I. Transportation of Persons Having Communi- cable Diseases. Section 1. Persons not allowed to travel. — No pei- son knowing or suspecting himself to be afflicted with plague, cholera, smallpox, typus fever, or yellow fever shall apply for, procure, or accept transportation in any railway train, car, or other conveyance of a com- mon carrier, nor shall any person apply for, procure, or accept such transportation for any minor, ward, patient, or other person under his charge if known or suspected to be so afflicted. Sec 2. Persons not accepted for travel. — Common carriers shall not accept for transportation in any rail- way train, car, or other conveyance any person known by them to be afflicted with any of the diseases enu- merated in section 1. Sec. 3. Restricted travel. — Common carriers shall not accept for transportation on any railway train, car, or other conveyance any person known by them to be afflicted with diphtheria, measles, scarlet fever, epidemic cerebrospinal meningitis, anterior poliomy- elitis, mumps, whooping cough, influenza, pneumonia, epidemic encephalitis, septic sore throat, rubella, claicken-pox, or erysipelas, or any person known to be a carrier of thes3 disaases, unless such person is placed in a compartment separate from other passengers, is accompanied by a properly qualified nurse or other attendant, and unless such nurs3 or attendant shall agree to comply and does so comply with the following regulations: {a) Communication with the compartment within which the patient is traveling shall be restricted to the minimum consistent with the proper care and safety of the patient. (6) All dishes and utensils used by the patient shall be placed in a 5 per cent solution of carbolic acid or other fluid of equivalent disinfecting value for at least one horn- after they have been used and before being allowed to leave the compartment. (c) All sputum and nasal discharges from the patient shall be received in gauze or paper, which shall be de- posited in a paper bag or in a closed vessel, and shall be • destroyed by burning. {d) Said nurse or attendant shall, after performing any service to the patient, at once cleanse the hands by washing them in a 2 per cent solution of carbolic acid or other fluid of equivalent disinfecting value. Sec. 4. Typhoid and dysentery. — Conmion carriers shall not accept for transportation on any railway train, car, or other conveyance any person known by them to be afflicted with typhoid fever, paratyphoid fever, or dysentery, unless said person is placed in a cornpartment separate from other passengers, is ac- companied by a properly qualified nurse or other attendant, and unless said nurse or attendant shall agree to comply and does so comply with the following regulations : {a) Communication with the compartment in which the patient is traveling shall be limited to the mini- mum consistent with the proper care and safety of the patient. (b) All dishes and utensils used by the patient shall be placed in a 5 per cent solution of carbolic acid or other fluid of equivalent disinfecting value for at least one horn* after they have been used and before being allowed to leave the compartment. (c) All urine and feces of the patient shall be re- ceived into a 5 per cent solution of carbolic acid or other fluid of equivalent disinfecting value, placed in a covered vessel and allowed to stand for at least two hours after the last addition thereto before being emptied. isl) A sheet of rubber or other impervious material shall be carried and shall be spread between the sheet and the mattress of any bed that may be used by the patient while in transit. EE(!OMMKNDATIONS ()]'■■ COMMITTEE ON HEALTH AND MEIJICAL RELIEl'. 6T (e) Said niirso or attendant shall use. all necessary precautions to prevent the access of flies to the patient or his discharges, and after performing any service to tlie patient shall at once cleanse the hands by washing them in a 2 per cent solution of carbolic acid or other fluid of equivalent disinfecting value. if) Provided, That if a person with typhoid or (.lysentery is presented at a railway station in ignorance of these regidations, and his transportation is necessary as a life saving or safe-guarding measure, an emergency may be declared and the patient may be carried a reasonable distance in a baggage car if accompanied by an attendant responsible for his care and removal: Provided also, That regulations (a), (6), (c), (d), and (e) of this section shall be complied with in so far as the circumstances will allow, and that all bedding, cloth- ing, rags or cloths, used by the patient shall be removed with him: And provided jurtTier, That any parts of the car which have become contaminated by any dis- charges of the patient shall be disinfected at the end of the run by washmg with a 5 per cent solution of carbolic acid or other fluid of equivalent disinfecting value. Sec. 5. Restricted application for transportation. — No person knowing or suspecting himself to be afflicted with any of the diseases mentioned in sections 3 and 4 shall apply for, procure, or accept transportation in any railway train, car, or other conveyance of a com- mon carrier, nor shall any person apply for, procure, or accept such transportation for any minor, ward, patient, or other person under liis charge, if known or suspected to be so afflicted, unless he shall have agreed to and made all necessary arrangements for complying and does so comply with the regulations set forth in said sections 3 and 4. Sec. 6. Suspected cases. — If a conductor or other person in charge of a railway train, car, or other conveyance of a common carrier, or an agent or other person in charge of a railway station, shall have any reason to suspect that a passenger or a person con- templating passage is afflicted with any of the diseases enumerated in sections 1, 3, and 4, he shall notify the nearest health officer, or company physician if the health officer is not available, by the quickest and most practicable means possible, of his suspicion: and said health officer or physician shall immediately proceed to the train, car, or other conveyance at the nearest possible point, or to the railway station, to determine whether such disease exists. Sec. 7. Disposition. — If the health officer or phy- sician, as provided for in section 6, shall find any such person to be afflicted with any of the diseases enum- erated in sections 1, 3, and 4, he shall remove such pc^rson from the station or conveyance, or shall isolate him and arrange for his removal at the nearest con- venif-nt point; shall treat the car or other conveyance as infected premises, allowing it to proceed to a con- venient place for proper treatment if in his judgment consistent with the public welfare, in such case notify- ing the health officer in whose jurisdiction the place is located; and shall take such other measures as will protect the public health: Provided, That if not pro- hibited in sections 1 and 2 of these regulations the afflicted person so found may be allowed to continue his travel if arrangements are made to comply, and he does- so comply, with the requirements of the section of these regulations pertaining to the disease with which he is afflicted. Sec. 8. leprosy. — Common carriers shall not accept for transportation nor transport in any railway train, car, or other conveyance any person known bj^ them to be afflicted withleprosy, unless such person presents per- mits from the Surgeon General of the United States Pub- lic Health Service or his accredited representative, and from the State department of health of the States from which and to which he is traveling, stating tha t such person may be received under such restrictions as wiU prevent the spread of the disease, and said restrictions shall be specified in each instance ; and no person know- ing or suspecting liimself to be afflicted with leprosy, nor any person acting for him, shall apply for, procure, or accept transportation from any common carrier unless such permits have been received and are pre- sented, and unless the person so afflicted agrees to comply and does so comply with the restrictions or- dered. If any agent of a common carrier shall suspect that any person in a train, car, or other conveyance, or at a railway station, is afflicted with leprosy, he shall proceed as directed in the case of other suspected dis- eases in sections 6 and 7 of these regulations. Sec. 9. Pulmonary tuberculosis. — Common carriers shall not accept for transportation any person known by them to be afflicted with pulmonary tuberculosis in a communicable stage unless said person is provided with (a) a sputum cup made of impervious material and so constructed as to admit of being tightly closed when not in use, (b) a sufficient supply of gauze, papers, or similar articles of the proper size to cover the mouth and nose while coughing or sneezing, (c) a heavy paper bag or other tight container for receiving the soiled gauze, paper, or similar articles; and unless such person shall obhgate himself to use the articles provided for in the maimer intended, and to destroy said articles by burning or to disinfect them by immersing for at least one hour in a 5 per cent solution of carbolic acid or other solution of equivalent disinfecting value; nor shall any person knowing himself to be so afflicted ap- ply for, procure, or accept transportation unless he shall have agreed to and made all necessary arrange- ments for complying and does so comply with the regu- lations as set forth in this section. Sec. 10. Conveyances vacated by infected persons. — Immediately after vacation by a person having any of the diseases mentioned in sections 1, 3, 4, and S, or at 68 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. the end of the trip on which such person was carried, the car or other conveyance shall be thoroughly cleaned, and the blankets and linen used by such person shall be laundered. II. Water and Ice Supplies. Sec 11. "Water to be certified. — Water provided by common carriers for drinking or culinary purposes in railway trains, caz's, or other conveyances, or in railway stations, shall not be taken from a supply which is not certified as meeting the required standards of purity and safety from contamination prescribed by the Inter- state Quarantine Regulations of the United States. Common carriers are required to forward semiannually a list of water supplies so used to the Surgeon General of the United States Public Health Service, Washing- ton, D. C, and to the respective State departments of health having direct jurisdiction, requesting the issu- ance of certificates of examination permitting the use of the supplies enumerated. Such certificates when issued shall be kept in the files of the common carrier during the current period in force. The issuance of a certificate imfavorable to the use of a supply forbids its further use for drinking and culinary purposes until favorably certified. A favorable certificate must also be secured permitting the use of any supplies substi- tuted for such condemned supplies. Melted natural ice used as water supply for drinking and culinary purposes must be from sources of known safety and covered by certificates of examination sim- ilar to those required for water supply for drinking and culinary purposes used in interstate traffic, and such ice must be so melted as to prevent subsequent con- tamination. Sec. 12. Ice. — Ice used for cooling water provided as in section 1 1 shall be clear natural ice, ice made from distilled water, or ice made from water certified as aforesaid; and before the ice is put into tlie water it ghall be washed with water of known safety, and han- dled in such manner as to prevent its becoming contam- inated by the organisms of infectuous diseases: Pro- vided, That the foregoing shall not apply to ice tliat does not come in contact with the water to be cooled. Sec. 13. Water containers. — Water containers in newly constructed cars and those newly installed in stations shall be so constructed that ice for cooling does not come in contact with the water to be cooled : Pro- vided, That after July 1, 1922, all water containers in cars and stations shall be so constructed that ice does not come in contact with the water. Sec 14. Care of water containers. — AU water con- tainers where water and ice are put into the same com- partment, shall be thoroughly cleansed at least once in each week that they are in use. All water containers and water storage tanks shall be thoroughly drained and flushed at intervals of not more than one month. All water containers shall, whenever practicable, be disinfected at intervals of not more than one month; and similar disinfection shall, whenever practicable, be made of water storage tanks. Sec 15. Filling water containers. — Portable hose or tubing that is used for filling drinking-water contain- ers, or car storage tanks from which such containers are filled, shall have smooth metal nozzles which shall be protected from dirt and contamination;- and before the free end or nozzle of said hose or tubing is put into the water container or car storage tank it shall be flushed and washed by a plentiful stream of water. III. Cleaning and Disinfection of Cars. Sec 16. General. — All railway passenger cars or other public conveyances shall be kept in a reasonably clean and sanitary condition at all times when they are in service, to be insured by mechanical cleaning at terminals and lay-over points. Sec 17. Cleaning. — All day coaches, parlor cars, buffet cars, dining cars, and sleeping cars shall be brushed, swept, and dusted at the end of each round trip, or at least once in each day they are in service, and shall be thorouglfiy cleaned at intervals of not more than seven days. Sec 18. Thorough cleaning. — Thorough cleaning shall consist of scrubbing the exposed floors with soap and water; similarly scrubbing the toilets and toilet- room floors; wiping down the wookwork with moist or oiled cloths; thorough dusting of upholstery and car- pets by beating and brushing, or by means of the vacuum process or compressed air; washing or other- wise cleaning windows ; and the thorough airing of the car and its contents. Sec. 19. Odors in cars. — When offensive odors ap- pear in toilets or other parts of the car which are not obliterated and removed by cleaning as in section 18, said toilets or other parts of the car shall be treated with a 1 per cent solution of forriialdehyde or other odor-destroying substance. Sec 20. Vermin in cars. — Whenever a car is known to have become infested with bedbugs, lice, fleas, or mosquitoes, such car shall be so treated as to effectively destroy such insects, and it shall not be used in service until such treatment has been given. IV. Cars in Service. Sec 21. Cleaning. — The cleaning of cars while occupied shall bo limited to the minimum consistent with the maintenance of cleanly conditions, and shall be carried out so as to cause the least possible raising of dust or other annoyance to passengers. Sec 22. Sweeping. — Dry sweeping of the interior of a car in transit with an ordinary broom is prohib-' ited. Sec 23. Dusting. — Dry dusting of the interior of a car in transit is proliibited. BEGOMMENOATIONS OF COiMMlTTKK ON HEALTH AND MEDIC!AL RELIEF. 69 Sec. 24. Brushing. — The )_)rii,shiiig of passengers' clothing in the ])ofly of the car in transit is prohibited. Sec. 25. Drinking cup. — Individual drinking cups in suflicient number shall be supplied in aU cars, and the use of common drinking cups is prohibited. Sec. 26. Towels. — The supplying of roller towels' or other towels for common use in cars is prohibited. Sec. 27. Comb and brush. — The supplying of combs and brushes for common use in cars is prohibited. Sec. 28.' Spitting. — Spitting on the floors, carpets, walls, or other parts of cars by passengers or other occupants of them is prohibited. Sec. 29. Cuspidors. — An adequate supply of cuspi- dors shall be provided in all sleeping cars, smoking cars, and smoking compartments of cars while in serv- ice. Said cuspidors shall be cleaned at the end of each trip, and oftener if their condition requires. Sec. 30. Brushing of teeth. — Spitting into or brush- ing the teeth over washbasins in cars is prohibited. Separate basins for brushing the teeth shall be pro- vided in the wash rooms of sleeping cars. Sec. 31. Drinking water and ice. — Drinking water and ice on railway cars shall be supplied in accordance with the conditions set forth in sections 11, 12, 13, 14, and 15 of these regulations. Sec. 32. Ventilation and heating. — All cars when in service shall be provided with an adequate supply of fresh air, and in cold weather shall be heated so as to maintain comfort. When artificial heat is neces- sary the temperature should not exceed 70° F., and in sleeping cars at night after passengers have retired it should not exceed 60° F. Sec. 33. Toilets in dining cars, — A proper toilet room and lavatory shall be provided in all dining cars for the use of dining-car employees, and the same shall be supplied with toilet paper, soap, and clean towels, and shall be kept in a clean and sanitary condition. Such toilet room shall have no direct connection with the kitchen, pantry, or other place where food is prepared. Sec. 34. Toilets in other cars. — A proper toilet room and lavatory shall be provided in all railway passenger cars, express cars, mail cars, and baggage cars for the use of their occupants. Such toilets shall be supplied with toilet paper, soap, and free or pay clean towels, and shall be kept in a clean and sanitary condition. Sec. 35. Toilets to be locked. — The toilet rooms in all railway cars shall be locked or otherwise protected from use while trains are standing at stations, passing through cities, or passing over watersheds draining into reservoirs furnishing domestic water supplies, unless adequate water-tight containers are securely placed under the discharge pipe. Sec. 36. Dining cars to be screened. — Dining cars shall be screened against the entrance of flies and other insects, and it .shall be the duty of dining-car employees to destroy flies or other insects that may gain entrance. Sec. 37. Dining car employees to cleanse hands. — Dining car employees shall thorough!}^ cleanse their hands by washing with soap and water after using a toilet or urinal, and immediately before beginning service. Sec. 38. Care of tableware. — All cooking, table, and kitchen utensils, drinking glas.^es, and crockery used in the preparation or serving of food or drink in dining cars shall be thoroughly washed in boUing water and suitable cleansing material after each time they are used . Sec. 39. Food containers. — Refrigerators, food boxes, or other receptacles for the storing of fresh food in dining and buffet cars shall be emptied and thor- oughly washed with soap and hot water and treated with a 1 to 3,000 solution of permanganate of potash or other approved deodorant at least once in each seven days that they are in use. Sec. 40. Food and milk. — No spoiled or tainted food, whether cooked or uncooked, shall be served in any dining car; and no milk or milk products shall be served unless the milk has been pasteurized or boiled. Sec. 41. Garbage. — Garbage cans in sufficient num- ber, and with suitable tight-fitting covers, shall be provided in dining cars to care for aU refuse food and other wastes, and such wastes shall not be thrown from the car along the right-of-way. Sec. 42. Dining car inspection. — The chief of the dining car shall be responsible for comphauce with all dining car regulations, and he shall make an inspection of the car each day for the purpose of maintaining a rigorous cleanliness in all portions thereof. Sec. 43. Examination of food handlers. — No person shall be employed as a cook, waiter, or in any other capacity in the preparation or serving of food in a dining car who is known or suspected to have any dangerous communicable disease; and all persons so employed shall undergo a physical examination by a competent physician before being assigned to service, and before returning to work after any disabling ill- ness, to determine their freedom from such diseases, and shall be immediately relieved from service if found to be so afflicted. There shall be a monthly medical inspection for dangerous communicable dis- eases. To determine persons afflictedw ith, or carriers of, typhoid fever, tuberculosis, dysentery, diphtheria, streptococcic sore throat, scarlet fever, gonorrhea, syphdis, etc., a laboratory examination shall be made if necessary. V. Eailway Stations. Sec. 44. General. — All railway stations, including their waiting rooms, lunch rooms, restaurants, wash rooms, and toilets, shall be kept in a clean and sani- 70 RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. tary coudition at all times, to be insured by mechanical cleaning at regular intervals. Sec. 45. Cleaning.^ — All waiting rooms and other rooms used by the public shall be swept and dusted daily; and at intervals of not more than seven days the floors shall be scrubbed with soap and water, and the seats, benches, counters, and other woodwork shall be similarly scrubbed, or shall be rubbed down with a cloth moistened with oil. Sec. 46. Sweeping. — If sweeping is done while rooms are occupied or open to occupancy by patrons, the floor shall be first sprinlded with wet sawdust or other dust-absorbing material. Sec 47. Dusting. — If dusting is done while rooms are occupied or open to occupancy by patrons, it shall be done only with cloths moistened with water, oil or other dust-absorbing material. Sec. 48. Spitting. — Spitting on the floors, walls, seats, or platforms of railway stations is prohibited. Sec 49. Cuspidors. — In all waiting rooms where smoking is permitted an adequate supply of cuspidors shall be provided; such cuspidors shall be cleaned daily, and oftener if their condition requires. Sec. 50. Common cups. — Individual drinking cups in sufficient number shall be supplied in all stations, and the use of common drinking cups is prohibited. Sec 51. Common towels. — The supplying of roller towels or other towels for common use in railway sta- tions is prohibited. Sec 52. Combs and brushes. — The supplying of combs and brushes for common use in railway stations is prohibited. Sec 53. Toilet facilities. — All railway stations where tickets are sold shall provide adequate toUet facilities, of a design approved by the State department of health, for the use of patrons and employees; and there shall be seperate toilets for each of the two sexes. Sec 54. Station toilets. — If a railway station is lo- cated within 300 feet of a public sewer, water-flushing toilets shall be installed and permanently connected with such sewer, and a wash basin or basins shall be located near the toilet and similarly connected; and svich toilets and lavatories shall be kept in repair and in good working order at all times. Sec 55. Care of toilets. — All toilets installed as set forth in section 54 shaU be cleaned daily by scrubbing the floors, bowls, and seats with soap and water. Sec. 56. Odors in toilets. — When offensive odors appear in toilets which are not obliterated and re- moved by cleaning as in section 55, said toilets shall be treated with a 1 per cent solution of formaldehyde or other odor-destroying substance. Sec 57. Toilet supplies. — Toilets and wash rooms installed as set forth in section 54 shall be constantly furnished with an adequate supply of toilet paper, soap, and free or pay clean towels. Sec 58. Privies. — If no sewer connection is avail- able as set forth in section 54, a sanitary privy of a design approved by the State department of health shall be maintained within a reasonable distance from the station. Such privy shall be adequately protected against the entrance of flies, shall be kept supplied with toUet paper, the seats shall be kept clean, and the vaults shall be treated with sodium hydrate or other approved disinfectant at least once in each week and shall be cleaned out and emptied at such intervals as will avoid the development of a nuisance. Sec 59. Drinking water and ice. — Drinking water and ice in railway stations shall be supplied in accord- ance with sections 11, 12, 13, 14, and 15 of these regu- lations. Sec 60. Water not usable for drinking. — If water which does not conform to the standards set forth in section 1 1 of these regulations is available at any tap or hydrant or in a railway station, a notice shall be maintained on each such tap or hydrant which shall state in prominent letters, "Not fit for drinking. " Sec 61. Drinking fountains. — If drinking fountains of the bubbling type are provided in any railway sta- tion, they shall be so made that the drinking is from a free jet projected at an angle to the vertical and not from a jet that is projected vertically or that flows through a filled cup or bowl. Sec. 62. Refuse cans. — At aU railway stations where there is an agent there shaU be provided and maintain- ed an adequate supply of open or automatically closing receptacles for the deposition of refuse and rubbish, and such receptacles shall be emptied daily and kept reasonably clean and free from odor. Sec 63. Cisterns, cesspools, etc. — All cisterns, water- storage tanks, and cesspools in or about railway sta- tions shall be adequately screened against the entrance of mosquitoes, and all collections of surface water on station property shall be drained or oiled during the season of mosquito fliglit, to prevent the breeding of mosquitoes. Sec 64. Restaurants to be screened. — All restau- rants and lunch rooms, or other places where food is prepared or served in a railway station, shall have doors and windows adequately screened against the entrance of flies during the season of flight of these insects; and aU food on display or storage racks shall be adequately covered. Sec 65. Lavatories for restaurants. — A lavatory of easy and convenient access shall be provided for the use of employees in every restaurant or lunch room in any railway station, and it shall be provided with an adequate supply of water, soap, and clean towels. Sec 66. Restaurant employees. — Restaurant em- ployees who are engaged in the preparing or serving of food shall thorouglily cleanse their hands by washing with soap and water after using a toilet or urinal, and immediately before beginning service. Sec 67. Kitchen and table utensils. — AH cooking, table, and kitchen utensils, drinking glasses, and crock- ery used in the preparation or serving of food or drink RECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. 71 in railway rPfStaurants or luncii rooms shall be thor- oughly washed in hoiling water and suitable cleansing material after each time they are used. Sec. 68. Food containers. — Refrigerators, food boxes, or other receptacles for the storing of fresh food in railway restaurants or lunch rooms shall be emptied and thoroughly washed with soap and hot water and treated with a 1 to 3,000 solution of perm.anganate of potash or other approved deodorant at least once in each seven days that they are in use. Sec 69. Garbage. — Garbage cans in sufficient num- ber, and with suitable tight-fitting covers, shall be pro- vided in all restaurants and lunch room.g to care for aU refuse food and other wastes; and such cans shall be emptied daily in an approved place and kept in a clean and sanitary condition. Sec 70. Restaurant inspection. — The manager, chief , or other person in charge of any railway restaurant or lunch room shall .be responsible for compliance with all regulations pertaining thereto, and he shall make an inspection of the premises daily for the pur- pose of maintaining a rigorous cleanliness in all parts thereof. Sec. 71. Station inspection. — The agent, manager, or other person in charge of any railway station shall be responsible for compliance with all regulations per- taining thereto, and he shall make, or have made by a responsible person reporting to him, frequent inspec- tions of the premises for the purpose of maintaining a rigorous compliance with aU such regulations. Sec 72. Examination of food handlers. — No person shall be employed as a cook, waiter, or in any other ca- pacity in the preparation or serving of food in a rail- way restaurant or lunch room who is known or sus- pected to have any dangerous communicable disease; and all persons so employed shall undergo a physical examination by a competent physician before being assigned to service, and before returning to work after any disabhng iUness, to determine their freedom from such diseases, and shall be immediately relieved from service if found to be so afHicted. There shall be a monthly medical inspection for dangerous communi- cable diseases. To determine persons afflicted with, or carriers of, typhoid fever, tuberculosis, dysentery, diphtheria, streptococic sore throat, scarlet fever, gonorrhea, sj^ihUis, etc., a laboratory examination shall be made if necessary. VI. Construction Camps. Sec. 73. Definition. — For the purposes of these regulations railway construction camps shall be con- sidered to include aU camps and similar places of tem- porary abode, including those on wheels, established by or for the care of working forces engaged in the con- struction, repair, or alteration of railway properties or parts thereof: Provided, That camps which are occu- pied by less than five people, or camps which are estab- lished to meet emergency conditions and are not occu- pied longer than five days .shall not be included, except that section 90 of these; regulations shall apply to them. Sec. 74. General. — All camps shall be so located and sc maintained as to be conducive to the health of their occupants and not to endanger the health of the pub- lic; and all tents, houses, stables, or other structures therein shall be kept in a reasonabl}^ clean and sanitary condition at all times. Sec. 7.5. location. — Camps, except those on wheels, should be located on high, well-draiiied ground: any natural sink-holes, pools, or other surface coUectioas of water in the immediate vicinity should be drained and filled when the camp is first established: and all such water not subject to complete drainage should have the surface oiled at intervals of not more than seven days during the season of mosquito flight. Sec 76. Arrangement. — The general scheme of re- lations of the structures of a camp should be as follows: The kitchen should be located at one end of the camp; next to this should be the eating quarters, then the sleeping quartei-s, then the toUets for the men, then the stable, thus bringing the kitchen and the stable at opposite ends of the camp, which should be as far apart as is consistent with the natural topography and the necessity for convenient access. Sec 77. Water supplies. — AU water supplies for camps shall be properly chlorinated, unless obtained from a source which has been approved by the State department of health. Sec. 78. Water containers. — All drinking-water con- tainers in camps shall be securely closed and so ar- ranged that water can be drawn only from a tap, and said containers shall be kept clean and free from con- tamination. Sec. 79. Garbage and refuse. — AU garbage, kitchen wastes, and other rubbish in camps shall be deposited in suitably covered receptacles, the contents of which shaU be emptied and burned each day; and manure from the stables shaU be likewise collected and burned each day, or disposed of in some other manner ap- proved by the State department of health. Sec. 80. Scavenger. — In aU camps where there are 100 men or more there shall be 1 employee whose duty shall be to act as scavenger and garbage collector. Sec 81. Toilets. — Every camp shall have an ade- quate number of latrines and urinals, so constructed and maintained as to prevent fly breeding and the pol- lution of water, and the use of such latrines and urinals by the inhabitants of the camp shall be made obliga- tory. Latrines and urinals may consist of deep trenches covered with houses adequately screened against flies, or of any other type approved by the State department of health. They shall not be located within less than 200 feet of any spring, stream, lake, or reservoir forming part of a public or private water supply. 72 RECOMMENDATIONS OF COMMITTEE ON HEAI^TH AND MEDICAL RELIEF. Sec. 82. Bathing facilities. — There shall be pro- vided in all camps adequate bathing facilities for the use of the occupants thereof. Sec 83. Screening. — The kitchen, eating houses, and bunk houses of aU camps shall be effectively screened against the entrance of flies and mosquitoes during the seasons of flight of these insects. Sec. 84. Care to tableware. — All cooking, table, and kitchen utensils, drinking glasses, and crockery used in the preparation or serving of food or drink in camps shall be thoroughly washed in boiling water and suitable cleansing material after each time they are used. Sec. 8.5. Food containers. — Refrigerators, food boxes, or other receptacles for the storing of fresh food iii camps shall be emptied and thoroughly washed with soap and hot water and treated with a 1 to 3,000 solu- tion of permanganate of potash or other approved deodorant at least once in each seven days that they are in use. vSec. 86. Food and milk. — No spoiled or tainted food, whether cooked or uncooked, shall be served in any camp; and no milk or milk products shall be served unless the milk has been pasteurized or boiled. Sec: 87. Examination of food handlers. — No person shall be employed as a cook, waiter, or in any other capacity in the preparation or serving of food in any camp who is known or suspected to have any danger- ous commimicable disease; and all persons so em- ployed shall undergo a physical examination by a com- petent physician before being assigned to service, and before retm'ning to work after any disabling illness, to determine their freedom from such diseases, and shall be immediately relieved from service if found to be so afflicted. There shall be a monthly medical in- spection for dangerous communicable diseases. To de- termine persons afflicted with, or carriers of, typhoid fever, tuberculosis, dysentery, diphtheria, streptococic sore throat, scarlet fever, gonorrhea, syphilis, etc., a laboratory examination shall be made if necessary. vSec. 88. Sick persons. — When an occupant of a camp becomes sick with a dangerous communicable disease, he should be immediately isolated and not released until declared by a proper health authority to be free from dangerous infection. Sec. 89. Vermin. — It shall be the duty of some one appointed as caretaker of the camp to make regular weekly inspections of the occupants and premises in order to ascertain the presence of lice or other vermin. Persons found to be infested shall be required to bathe, and their clothing shall be boiled; and premises found to be infested shall be fumigated with solphur or treated by some other effective vermin-destroying method. Sec. 90. Abandoned camp.'j. — When any camp is to be abandoned, all garbage, rubbish, and manure shall be collected and burned, the latrine trenches filled, and the grounds and buildings shall be left in a clean and sanitary condition. Sec. 91. Duty to enforce regulations. — It shall be the duty of the superintendent, foreman, or other person in charge of a camp to see that all regulations pertaining thereto are faithfully complied with. VII. Offices. Sec. 92. Definition. — For the purposes of these regulations offices shall be considered to include all buildings or parts of buildings occupied or used as the offices, headquarters, or working spaces of the cler- ical administrative, or executive forces of railways or other common carriers. Sec. 93. Space. — AU offices shall contain not less than 400 cubic feet of space for each occupant. Sec. 94. Ventilation, heat, and light. — All offices when occupied shall be provided with an adequate supply of fresh air, heat, and. light for the mainte- nance of healthful and comfortablfe working conditions. Any measures taken to assure continuous ventilation during working hours should be supplemented by the opening of doors and windows for at least five minutes before the beginning of morning and afternoon work periods and once during each of such periods. When artificial heat is necessary, the temperature should not exceed 70° F. Window space should be sufficient to allow of the use of natural skylight in all parts of offices during the brighter parts of the day, and when arti- ficial lights are used they should be so arranged and shaded as to prevent direct glare. Sec. 95. Cleaning. — All offices, together with the corridors, stairs, or passageways leading to them, shall be swept and dusted daily; and at intervals of not more than seven days the floors shall be scrubbed with soap and water, and the woodwork and furniture rubbed clean with a cloth moistened with water or oil. Cleaning shall not be carried on while offices are occu- pied by employees, except in offices wliich are occupied continuously; and in such case sweeping may be done only after the floor has been sprinkled with wet saw- dust or other dust-absorbing material, and dusting only with a cloth moistened with water or oil. Sec. 96. Window cleaning. — Office windows shall be washed or otherwise cleaned at such intervals as will assure a free and uninterrupted flow of light to office interiors, and in no case shaU such cleaning be less frequent than once in each month. Sec. 97. Telephones. — Telephone earpieces and mouthpieces should be cleaned with soap and water at least once in each week. Sec. 98. Spitting. — Spitting on the floors, walls, stairways, or other parts of offices or office buildings is prohibited. Sec. 99. Cuspidors. — If cuspidors are provided in offices or office buildings they shaU be cleaned daily, and oftener if their condition requires. EECOMMENDATIONS OF COMMITTEK ON HEALTH AND MEDICAL RELIEF. Sec. 100. Toilets.— All ofl3.ces and office buildings shall be provided with adequate toilet and lavatory facilities of an approved sanitary type, conveniently located for the use of employees; and wher.e members of both sexes are employed, separate toilets shall be maintained for each sex. Where a sewer is available, toilets shall be of the water-flushing type and per- manently connected thereto. Sec. 101. Care of toilets. — All toilets installed as set forth in section 100 shall be kept in repair and in good working order, and shall be cleaned daily by scrubbing the floors, bowls, and seats with soap and water. When offensive odors appear in toilets which are not obliterated and removed by cleaning as above set forth, said toilets shall be treated with a 1 per cent solution of formaldehyde or other odor-destroying sub- stance. Sec. 102. Toilet supplies. — Toilets and lavatories installed as set forth in section 100 shall be furnished with an adequate supply of toilet paper, soap, and clean towels. Sec. 103. Common towels. — The supplying of roller towels or other towels for common use in offices or office buildings of common carriers is prohibited. Sec. 104. Combs and brushes. — The supplying of combs and brushes for common use in offices or office buildings of common carriers is prohibited. Sec. 105. Common cups. — Individual drinking cups in sufficient number shall be supplied in the offices of common carriers, and the use of common drinking cups is prohibited. Sec. 106. Drinking water and ice. — If the drinking water provided in offices or office buildings of common carriers is not obtained from an approved municipal supply, or is not distilled or otherwise sterilized before being used, it shall be subject to the conditions set forth in section 11 of these regulations. Ice used for cooling drinking water shall be subject to the condi- tions set forth in section 12 of these regulations; and drinking-water containers shall be subject to the con- ditions setforth in sections 13, 14, and 15 of these regu- lations. ,.■{, Sec. 107. Drinking fountains. — If drinking foun- tains of the bubbling type are provided in the offices or office buildings of common carriers, tliey shall be so made that the drinking is from a free jet projected at an angle to the vertical, and not from a jet that is pro- jected vertically or that flows through a filled cup or bowl. Sec. 108. Lockers. — If lockers are supplied for the use of employees, tliey shall be kept clean and free from discarded clothing. ,,,,,. Sec. 109. Eest rooms. — A rest room shall be pro- vider! in all offices or office buildings of common carriers where 100 or more women are employed; and such room is desirable where any smaller number of women are employed. Seg. 110. Communicable diseases. — Wlien an em- ployee who is convalescent from a communicable dis- ease reports for duty, such employee shall not be allow- ed to resume work until a satisfactory certificate or release from the health officer having jurisdiction has been secured stating that there is no remaining danger of his communicating disease to other people. VIII. Shops. Sec. 111. Toilet facilities. — All repair, constructing, or other shops of common carriers shall be provided with adequate toiletfacilitiesfor the use of the employ- ees; and if both men and women are employed, such facilities shall be separate for the two sexes. Wliere running water and sewers are available, all toilet fix- tures shall be permanently connected thereto. Sec. 112. Type of water-closets. — Water-closets should be of the individual bowl type with individual water seal; flush range closets shall not be used. The seats should be wood or other poor conducting material, and should be rendered impervious to water by coating with varnish or by other means. The seats should be of the cut-out-front type, or if closed in front, the openings should be at least 7 inches wide by 11 inches long. Sec. 113. Closet inclosures. — The separate seats of ivater-closets shall be so inclosed as to secure privacy for the users. Between the seats there should be partitions about 6 feet high and 12 inches off the floor, and each inclosure should have a swinging door of proper height. Each inclosure should have not less than 10 square feet of floor space and not less than 100 cubic feet of air sjiace, and the walls and partitions should be of light color to increase illumination and facilitate cleaning. The floors shoidd be of tile or concrete with a smooth surface and should be non- absorbent. Sec. 114. Windows in toilet rooms. — All toilet rooms containing water-closets should be open to outside light and air. The minimimi window space for a room containing one closet fixture should be four square feet, and for each additional fixture there should be an addition of two square feet of window space. Windows should be so arranged that they can be opened for affording free ventilation. Sec. 115. Equipment of closets. — All closet in- closures shall be equipped with clothes hooks and with a plentiful supply of toilet paper with proper holder. Sec. 116. Type of urinals. — Urinals should be of the vertical slab or the porcelain stall type with proper flushing; troughs or basins shall not be used for this purpose. There should be protection around urinals to secure privacy. The floor in front of the urinal should be impervious and nonabsorbent and should slope to drain. 74 BECOMMENDATIONS OF COMMITTEE ON HEALTH AND MEDICAL RELIEF. Sec. 117. Care of closets and urinals. — All water- closets and urinals, together with the floors, bowls, and seats, shall be kept in a reasonably clean and sani- tary condition at aU times. They should be cleaned by scrubbing with soap and water daily, and when offensive odors develop which are not removed by such cleaning, they should be treated with a 1 per cent for- maldehyde solution or other odor-destroying sub- stance. Sec. 118. Number of closets and urinals. — Closets should be installed in the proportion of 1 to each 25 employees on any one shift; and urinals should be in- stalled in the proportion of one to each 50 male em- ployees on any one shift. Sec. 119. Location of closets and urinals. — Closets and urinals should be located as conveniently as pos- sible to work. There should be a number of small in- stallations rather than a few larger ones. Sec. 120. Privies. — Where water and sewer connec- tions are not available, sanitary privies of a type ap- proved by the State department of health shall be provided, with a ratio of not less than 1 seat to each 25 employees on any one shift. They shall be adequately protected against the entrance of flies, and shall be kept in a clean and sanitary condition at aU times. The vaults shall be treated with caustic soda or other approved disinfectant at intervals of not more than seven days, and shall be emptied at such intervals as wiU avoid the development of a nuisance. Sec. 121. Wash rooms and lockers. — Ample washing facilities and locker space shall be provided for em- ployees. If possible, wash rooms and locker rooms should be along the routes of employees when going from work, and so located as to avoid undue hazard or exposure to the weather in reaching them. They should be separated from toilet rooms by partitions or otherwise, and should open to outside light and air. Sufficient window space should be provided to afford adequate light and ventilation. Sec. 122. Type of wash rooni fixtures. — Facilities for washing should be either so constructed that the users must necessarily wash from a flowing stream, or individual basins; and no large basins or troughs for common use should be installed. Both hot and cold water, delivered through a common discharge pipe, should be supplied to each fixture. Soap should be provided; and fixtures should be so spaced that a man can wash without splashing his neighbor. Sec. 123. Finish of wash floors. — The floors of wash rooms should be of concrete or other nonabsorbent material and should slope toward central drains. The walls, ceilings, and partitions should be light in color to increase illumination and to facihtate cleaning, and the rooms should be adequately lighted artificially so that no dark corners will exist. Sec. 124. lockers. — A locker or other provision for caring for a change of clothing shall be supphed for each employee who has a fixed place of work. Lockers should be elevated at least 4 inches off the floor, should be not less than 12 by 15 inches in floor dimensions, and should be ventilated by perforated doors or otherwise. Sec. 125. Bathing facilities. — Shower baths shall be provided in the proportion of 1 to each 25 employees for all employees who work with lead, paint, or in very dusty or dirty places. They should be located adjoining locker rooms, should be inclosed so as to af- ford privacy, and should be supplied with hot and cold water delivered through a common discharge pipe. The floors should be of concrete or other non- absorbent material and should slope to a central drain. Sec. 126. Caretakers. — There shall be caretakers in sufficient number responsible for the cleaning, sup- plying, and upkeep of toilets, wash rooms, and locker rooms. Sec. 127. lighting. — In all shops and parts of shops there shall be an adequate amount of light for the occupation or process being carried on therein; and the glare of direct light passing from unshaded sources directly to the eyes of workers should be avoided. Wherever shops are dependent upon window lighting, the glass shall be kept clean. Sec. 128. Water supplies. — An adequate supply of drinking water, conveniently located for the use of employees, shall be supplied in aU shops. If the drinking water provided is not obtained from an approved municipal supply, or is not distilled or otherwise sterilized before being used, it shall be subject to the conditions set forth in section 11 of these regulations. Ice used for cooling drinking water shall be subject to the conditions ret forth in section 12 of these regulations, and drinking-water containers shall be subject to sections 13, 14, and 15 of these regulations. Sec. 129. Drinking fountains. — If drinking foimtains of the bubbling type are provided, they shall be so made that the drinking is from a free jet projected at an angle to the vertical, and not from a jet that is projected vertically or that flows through a filled cup or bowl. Sec. 130. Common cups. — The use or supplying of drinking cups for the common use of employees is prohibited. Sec. 131. Common towels. — The use or supplying of roller towels or other towels for the common use of employees is prohibited. Sec. 132. Rest rooms. — A rest room shall be pro- vided in all shops where 100 or more women are em- ployed; and such room is desirable where any smaller number of women are employed. Sec. 133. Communicable diseases. — When an em- ployee who is convalescent from a communicable dis- ease reports for duty, such employee shall not be allowed to resume work until a satisfactory certificate or release from the health officer having jurisdiction has been secured stating that there is no remaining danger of his communicating disease to other people. recommendations of committee on health and medical relief. Exhibit E. 75 GENERAL AND DEPARTMENTAL RULES GOVERNING PHYSICAL EXAMINATIONS OF APPLICANTS FOR EMPLOYMENT, PROMOTION, AND PERIODIC EXAMINATION IN ORDER TO DETERMINE THEIR FITNESS FOR SERVICE, AS RECOMMENDED BY COMMITTEE. GENERAL RULES. * 1. The essential qualifications for various positions shall be determined by the examinations herein pre- scribed. 2. Examinations' shall not be made when a can- didate has just come in from a run or been subjected to unusual fatigue. 3. Candidates for employment or selected for pro- motion shall pass the required examinations and tests before being permitted to enter upon the duties of the position sought. 4. The general mental characteristics and bearing of the candidate, such as confident, diffident, bright, dull, quick, slow, etc., shall be noted on the applica- tion blank by the examiner. 5. Reexaminations may be ordered at any time by proper authority. 6. Applications shall be approved or rejected by proper authority. 7. The various roads shall prescribe a form which will properly take care of examination records. 8. The date of reexamination shall be computed from the time of the last physical examination. If there has been no previous physical examination, the date of reexamination shall be computed from the date these regulations become effective. 9. If an employee subject to reexamination is relieved from service or his service changed as a result of the examining physician's findings, he may appeal to a medical board composed of one physician chosen by the railroad and one by the employee ; if this board fails to agree, it shall select a third member. The members of the board shall be men of good standing in the community and of recognized professional ability. The expense of examination shall be assumed by the railroad. The findings of the board shall be considered as final and submitted to the proper authorities. 10. Employees when examined for promotion or periodically are found to have any of the disqualifying defects applying to applicants for service, a full report of such defect or defects shall be made to officer to whom the examiner reports. No such employee shall be relieved from service without the approval of the general manager or his accredited representative. *A physical examination may be made at any time on request of the employing officer, the employee, or on written request of three fellow employees. DEPARTMENTAL RULES. Transportation Department. AGE limit. 11. With the exception of clerks, messengers, and call boys, the minimum ago shall be 21 years, maxi- mum 45 years. 12. The ma.ximum age for inexperienced applicants for positions as firemen or brakemen shall be 3.5 years. PHYSICAL EXAMINATION. 13. Applicants for service shall undergo a phj-sical examination including vision and hearing. Appli- cants for train service and for other positions connected in any manner with the operation of trains shaU in addition pass a satisfactorj^ examination on colors. 14. Examining physicians shall recommend for rejection applicants whose hearing and vision (and color sense when required) do not conform to stand- ard, or who are found to be physically or mentally unfit. PROMOTION. 15. Employees before being promoted shall undergo a physical examination including vision and hearing, and in certain classes as covered by rule 17 also shall pass a satisfactory examination on colors. PERIODIC PHYSICAL EXAMINATION. 16. Employees in train service or holding other positions in any manner connected with the operation of trains shall undergo a physical examination includ- ing vision, hearing, and colors at least every five years. 17. Employees who are 45 years of age or over in train service or holding other positions in any manner connected with the operation of trains shall undergo a physical examination including vision, hearing, and colors every two years. Maintenance of Way Department. age limit. 18. With the exception of clerks, water boys, and messengers, the minimum age shaU be 18 years, maximum 45 years. PHYSICAL EXAMINATION. 19. Applicants for service shall undergo a physical examination including vision and hearing. Appli- cants for positions connected in any manner with the operation of trains shall in addition pass a satisfactory examination on colors. 76 RECOMMENDATIONS OF COMMITTEE OW HEALTH AND MEDICAL RELIEF. 20. Examining physicians shall recommend for rejection applicants whose hearing and vision (and color sense when required) do not conform to standa,rd, or who are found to be physically or mentally unfit. PROMOTION. 21. Employees promoted to positions comiected in any manner with the operation of trains shall undergo a physical examination including vision, hearing, and colors. PERIODIC PHYSICAL EXAMINATION. 22. Employees connected in any manner with the operation of trains shall undergo a physical examina- tion at least every 5 years, including vision, hearing, and colors. 23. Employees who are 45 years of age or over con- nected in any manner with the operation of trains shall undergo a physical examination, including vision, hearing, and colors every two years. Maintenance of Equipment Department. [Does not apply during the existence of the agreement between the United States Railroad Administration and the Railway Em- ployees Department of the American Federation of Labor, Me- chanical Section, and Divisions Nos. 1. 2, and 3, because of rule 46.] AGE LIMIT. 24. With the exception of clerks, messengers, call boys, and apprentices, the minimum age shall be IS years, maximum 45 years. PHYSICAL examination. 25. Applicants for service shall undergo a physical examination, including vision and hearing. Appli- cants for positions connected in any manner with the operation of trains shall in addition pass a satisfactory examination on colors. 26. Examining physicians shall recommend for re- jection applicants whose hearing and vision (and color sense when required) do not conform to standard, or who are found to be physically or mentally unfit. promotion. 27. Employees promoted to positions connected in any manner with the operation of trains shall undergo a physical examination, including vision, hearing, and colors. 28. Employees who by nature of their employment might because of sudden physical incapacity endanger the lives of fellow employees shall undergo a physical examination. periodic physical examination. 29. Employees connected in any manner with the operation of trains shall undergo a physical examina- tion at least every five years, including vision, hear- ing, and colors. 30. Employees who by nature of their employment might by sudden physical incapacity endanger the lives of other employees shall undergo a physical exami- nation at least every five years. 31. Employees subject to examination for promo- tion and periodic examination who are 45 years of age or over shall undergo a physical examination at least every two years. RULES GOVERNING VISION EXAMINATION. 32. A set of at least two standard cards of Snellen's test letters showing letters of various sizes from 20 to 70, inclusive. The letters to be arranged in different order in the corresponding lines of each card. 33. A standard reading test card with matter printed in various type. 34. A test spectacle frame with opaque disk. Note. — The following may be used if desii'ed: A set of test cards showing semaphores in various positions. Method of Testing, letter card test. Place the candidate to be examined so that he will not face a strong light; cover one of his eyes with opaque disk in test frame ; place one of the cards at a distance of 20 feet from him, in a clear light, but not in direct sunlight, and direct him to read the letters on certain lines as selected by the examiner, including the line marked 20. A portion of the test card may be covered and the candidate required to read the re- mainder of the line of letters, or certain letters at each end of the line may be covered and the candidate re- quired to read the intervening letters. If he can read the letters on the line marked 20 correctly, substitute another card with a different arrangement of letters and test in a similar manner. If he reads the letters on the line marked 20 on both cards correctly, it indi- cates normal vision. If he can not read the letters on the line marked 20, direct him to read the lines above 20 successively until a line is found which he can read. Record in fractions the acuteness of vision as deter- mined, the numerator being 20 (the distance at which the card is placed) and the denominator the number on the card showing the smallest sized letters that he has read correctly. Repeat this test with the other eye and record the results. Mistakes of not more than tliree letters on the 20 line; two letters on the 30 line; and one letter on the 40 line will be considered as a satisfactory reading. Other lines must be read with- out error. READING CARD TEST. Direct the candidate to read certain letters or sen- tences from the standard reading test card and record the smallest size of print read correctly at the ordinary distance of from 14 to 18 inches. A portion of the test card may be covered and the candidate required to read the remainder of the paragraph. The candidate should be able to read the print in paragraph two of the standard card to pass the test satisfactorily. This test should be made without glasses except at the age or under the coiaditions where the use of glasses is per- mitted. EEGOMMENDATIONS OK COMMITTEE ON HEALTH AN]J MEIJICAL RELIEF VISUAL STANDARDS. 77 Occupation. Enginemen and fiiemcn. road service. Engiuenien and firemen, yard service. Passenger coiidiick)r.s, passenger brakemen, passenger baggage masters, yard conductors, yard brakemen, freight conductors, freight brakemen, flagmen. To enter service. 20/20 in each eye tested sepa- rately, without gla.sses. 20/20 in cacli rye. lesled .-^cpa- ralclv. withoul glasses. 'l"o be promoted. 20/20 in one eye and nol less tlian 20/:W in "the other. teste