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. 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" 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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