agree upon tests of sight suitable to be enforced in the case of signallers and look-out men and such, by land or sea, with a view to the safety of life and property. This resolution emanated from the Ophthalmological Section, and was drawn up by a committee consisting of the following persons, all of whom had made themselves conspicuous by their studies upon this subject, and by their labors to effect this reform by appeals to the authorities of their various nations: Chairman, Prof. Donders, for the Netherlands; Mr. Wm. Bowman, for Great Britain; Dr. Dufour, for Switzerland; Dr. Gama Lobo, for Brazil; Dr. Samuel T. Knaggs, for N. S. Wales; Prof. Leber, for Germany; Dr. Libbrecht, for Belgium; Dr. L. Maréchal, for France; Dr. Ole Bull, for Norway; Dr. Osio, for Spain; Dr. Reymond, for Italy; J. T. Rudall, F.R.C.S., for Victoria; Prof. W. Thomson, for the United States; Dr. Warlomont, for Belgium; Secretary, Dr. Brailey, London.

was agreed that with it any properly instructed non-medical person could make the first examinations, and transmit the results for the decisions of a medical authority; and that large bodies of men might thus be safely passed through the testing without the presence of medical examiners. One member of the committee has already sent to me for the instrument, with the statement that he will advise his government to employ it on the railways; and another instrument has been sent through the British Consul at Philadelphia, at the request of the Secretary of the Marine Department, for the use of the Board of Trade in London.

In giving, then, the details of the system for examination into the "sight, color sense, and hearing," which was prepared by me for the Pennsylvania Railroad, and perfected by the aid of a committee of their transportation officers, and which has been adopted, I feel that a decided step forward has been made, and that the ideas which underlie it are substantial, viz., 1. That it would be impossible by any agitation to subject a road passing through many sovereign States to legislation which might be considered hostile to its interest. 2. That for the pro

In the hope that a common standard for land and sea, which would give a qualitative as well as a quantitative test for color sense, might come into general use, the committee will recommend the iso-chromatic tables on the principle of Stilling, consisting of squares of confusion colors and test colors intermingled so as to form letters, but which will be found too complicated to be trusted to any but trained examiners of special educational fitness, or, in other words, medical men acquainted with the diseases and defects of the eye.

The European idea seems to be to propose to the governing powers an organization composed of medical experts in sufficient number, who shall personally examine the railway employés under the direction of some one or more eminent ophthalmic surgeons, to be paid by the government, to establish a standard for sight and color sense, and to give or withhold certificates which will entitle the men to remain in or leave the service. From the failures to secure this control it may be inferred that opposition has been successfully made by the railways, or that the persons in authority have not been convinced of the practical value of the schemes. No steps have yet been taken in England, and it is felt that there, as in this country, no amount of agitation would suffice to bring the railways under such legislation.

Upon the conclusion of the labors of the committee, the plan described below was briefly mentioned as the one most feasible in our country, and much interest was shown in it, and in the instrument for the use of the detection of color defects; and it

The signal failure to carry out State legislation obtained by public agitation in Connecticut, under which scientific experts, designated by the Governor, and paid by the road, were provided for; and fixing severe penalties for the employment of any man not provided with experts' certificates, proved that the officers of the roads were not willing to submit their employés to the scrutiny of State officials who, adopting their own standards, could practically summarily discharge perhaps fifteen per cent. of their men, disturb the discipline and impair the organization of their roads; whilst the political power of a large number of such employés, each with a ballot, was fully demonstrated in their successful demand for the repeal of this law. Any advice on this subject to be accepted by the railway officials ought to be given by scientists of their own selection, and must be confidential, in order that they may either discharge men unfit for service, or transfer to positions where they can do no harm those who by education are too valuable to be lost to their service; whilst the men would gladly accept any wise precautions against the dangers of their occupation which could be provided for their own safety.

These difficulties are overcome by the employment of the instructions which I have prepared for the use of the Pennsylvania Railroad, and which can be followed by a non-medical person, properly instructed, who will place the results on a blank, and transmit them to the professional expert having supervision of the entire examination. From these data a just de

cision can be made as to the sight, color sense, and hearing of each employé.

In accordance with a wish expressed many months ago, that I should suggest some practical method for the examination of the employés of the Pennsylvania Railroad, as to their ability to see the colored signals by day and night used in the service, I de

a person has a good color sense, his record will exhibit none but odd numbers; whilst, if he is colorblind, the mingling of even numbers betrays his defect at a glance to the supervising expert or superintendent.

There are forty tints on the stick, and the first twenty are given to the detection of color-blindness, using the test-green, and if the color sense is deficient, it will surely be revealed.

To distinguish, however, between green-blindness and red-blindness, the rose-test is used, and those color-blind will select indifferently, either the blues intermingled with the rose, between figures 20 and 30, or perhaps the blue-green or grays from 1 to 20, and thus reveal their defect, and establish either greenor red-blindness.

Finally, the red-test corroborates these results, and satisfies the most sceptical of color defect, when the "confusion tints" or even numbers between 30 and 40 are selected.

On a suitable blank these figures are placed in the order of examination, and a glance of the eye reveals the color sense of the person examined; since, if anything but odd numbers are chosen, there is a defect; or if, with test one, anything beyond 20 is chosen; or if, with test two, anything but odd numbers between 20 and 30; or, with test three, anything but odd numbers between 30 and 40. The colors can readily be changed in the instrument, if it should be found desirable.

It is theoretically and practically a fact, that the tints as arranged on the instrument look quite the same in color to color-blind persons, and that those having a perfect color sense can thus form an idea of this infirmity. If, then, green and gray are indistinguishable, and green and red, when of the same depth of color, seem to be entirely the same to the color-blind, it needs no opinion from a scien

It is a fact that some of the color-blind promptly give the proper names to the flags, and answer correctly, when asked, what they would do in presence of such signals but it must be remembered that they may see perfectly, and have always had some perception of these colors, and do give them their conventional names, perhaps, but that they are unable to distinguish them at once and infallibly, and that it will only require a further extension of our method of testing to demonstrate the inability of persons color-blind to our examination to recognize the signals, by day or night, which are now depended upon to prevent accidents of the gravest character. This must be done by demanding that the signals be matched, and not named, and is incorporated in the instructions herewith submitted, so that the tints which color-blind men select with the railroad signals, may hereafter be known and recorded.

My conclusions from a study of the subject in connection with the railway service are:

1. That there are many employés who have defective sight, caused either by optical defects, which are, perhaps, congenital, and which might be corrected with proper glasses, or due to the results of injuries or diseases of the eyes, remediable or not, by medical or surgical treatment.

2. That one man in twenty-five will be found color-blind to a degree to render him unfit for service where prompt recognition of signals is needed, inasmuch as color-blindness for red and green renders signals of these colors indistinguishable. It is a fact in physiological optics, however, that yellow and blue are seen by those color-blind for red and green, and that yellow-violet blindness is so rare that it might lead to the use of these yellow and blue colors, in preference to red and green, wherever possible.

3. That color-blindness, although mainly con

genital and incurable, is sometimes caused by disease or injury, and that precautions might be needed to have either periodical examinations or to insist upon it in cases where men have suffered from severe illness or injury, or when they have been addicted to the abuse of tobacco or alcohol.

4. That the method, when adopted, will enable the authorities to know exactly how many of their employés are "satisfactory in every particular" as to sight and hearing; and that the examination will have the further value of making the division superintendents acquainted with the general aptitude of the men in their divisions as to general intelligence. 5. That the entire examinations can be made at the rate of at least six men an hour; whilst that for color sense alone can be done in a very few minutes for each man by an intelligent employé.

6. That to secure the confidence of the employés, and of competent scientific critics, as well as of the public generally, it is advisable to have some official professional specialist to whom all doubtful questions could be referred, and who should be held responsible for the accuracy of the instruments, test cards, etc., to be put in use, and who should have general supervision of the entire subject of sight, color sense, and hearing.

7. That from the impossibility of subjecting the immense number of employés on our large railways to the inspection of the few medical experts available, and to secure the examination of those hereafter to be employed, some system of testing by the railway superintendents has become a necessity, and it is believed that the one prepared will answer the purpose. By request, these views were communicated to the proper officials of the Pennsylvania Railroad Company, and on July 1, 1881, I received a communication from the General Manager, from which I make the following extract :

"DEAR SIR: I beg leave to inform you that the apparatus invented by you, and the rules and regulations entitled 'Instructions for examinations as to vision, color sense, and hearing,' prepared by a committee of transportation officers of the Pennsylvania Railroad and yourself, for the use of our officers in examining employés for defects of sight and hearing, were laid before the Board of Directors, who approved and adopted them, and authorized me to put them into effect, subject to such changes from time to time as experience may prove to be necessary for the proper working of the system.

"In putting these rules into effect, I take pleasure in designating you as the expert to whom, under the rules, such cases shall be referred as may require the judgment of an expert."

A CONTRIBUTION

IN REFERENCE TO THE TREATMENT OF COMPOUND FRACTURES OF THE LEG.2 BY ERSKINE MASON, M.D.

HAVING been interested lately to arrive at a knowledge of the usual period of time required for

1 The official instructions will be found under the head of " 'Notes and Queries," p. 59.

2 Read before the New York Surgical Society, Nov. 22, 1881.

the repair of a compound fracture of one or both bones of the leg, as well as the method employed which seems best to answer the indications of treatment, as well as add to the comfort of patients in the majority of cases that pass under our observation, I was led to study the result of my own experience with these cases.

I find, that though a large number of these cases have passed under my observation, I am only able at present to gather complete notes of thirty cases from the time of accident to the period of their discharge. These cases have been selected from hospital practice, and represent all the varieties and various features, both as to constitution of patient and character and cause of accident, that the surgeon meets with in his ordinary hospital service. From my recollection of other cases that have been either entirely or partially under my observation and treatment, the results are about the same as those obtained from the analyses of the thirty cases. I think I have made use of almost every kind of splint and variety of dressing in the treatment of these cases, and I have come to the conclusion that the plaster-of-Paris dressing in some one of its varieties, but chiefly the plaster bandage, with or without brackets, meets the indications in the majority of cases, either applied at once or later on in the case, better than any other appliance I have resorted to. I am well aware of the dangers which may arise in its use, but to those who are accustomed to its application, and with the requisite care and watchfulness that these cases require, I think the risks are slight and may be avoided.

The objections that some have raised as to the want of cleanliness, from the discharges flowing beneath the bandage, I believe are preventable, and when suitably bracketed, may be adapted to almost every case.

Where from various causes it would not be advisable to use the permanent dressing at once, in my hands no apparatus has seemed to give more comfort to the patient than the fracture-box, with the limb surrounded by bran, as first used, I believe, by Barton.

Though much that has been said in favor of plaster dressings may be applicable to other permanent dressings; still, the ease with which the plaster bandage is applied and fenestra cut in it, causes me to give it the preference, as well as the ease in this dressing with which the antiseptic treatment may be employed.

Some months ago a plan was adopted by some of our hospital surgeons of wrapping the leg up in large quantities of either carbolized or salicylized jute in addition to the ordinary Lister dressings, but without any other support to the limb. Though these dressings were to be removed as seldom as possible, still the changes in some had to be made frequently, at least for the first week or ten days of treatment. I have not only had the opportunity of observing this practice in the patients of others, but have given it a trial myself in several cases. It has been abandoned by me, however, for the following

I have met with the same gratifying result from this treatment in two cases of fracture of the femur occurring in boys, and in one case of both bones of the fore-arm in an adult, but in these cases the injury to the soft parts was but slight. I merely allude to these cases, however, as I propose to confine my remarks to fractures of the leg.

The two cases whose histories I have given were certainly such as I of late have been accustomed to treat with drainage-tubes introduced at the first dressing; and I watched their progress with much interest. They certainly have gone far to confirm what my observations have for some time been leading me to entertain, namely, that at present we are apt to be too free in the use of the drainage-tube in these cases, at least we resort to them too freely in many cases immediately upon the receipt of injury. We introduce them to anticipate the burrowing of pus, and to remove as expeditiously as possible the discharge we expect to take place. Whereas the presence of these very tubes, when too freely used, I feel sure, at times have by their presence in the soft parts invited the secretion of pus, and kept up the discharge which we desire to avoid. Certainly, I have seen two and three tubes introduced at once where I feel certain that one for the present would suffice; if indications for more arise they may be introduced later without detriment to the case.

We never can be sure if the discharge will burrow, nor the direction it will take; hence, I think at first we should be moderate in the use of the tubes.

One other point with reference to drainage-tubes. I fear that in many instances we allow them to remain too long, and, acting as foreign bodies (which they are), tend to keep up a discharge, and delay the conversion of a compound into a simple fracture. Again, when left in a long time, their tracks through the soft parts acquire callous walls, which sinuses after the removal of the tubes are long in closing.

Experience has taught us all, I believe, that since the introduction of antiseptic measures we are now enabled to save limbs that before would have been condemned to amputation. Observation, however, has shown me that we may have too implicit faith at times in the efficacy of antiseptics, and that we may attempt to save limbs which more judicious judgment, as results have proved, should have been condemned, or save limbs which are of no service to the patient, and subsequently have to be removed.

Of the thirty cases of compound fracture of the bones of the leg, we find sixteen of the tibia, three of the fibula, while of both tibia and fibula there are eleven. Seven of these cases required amputation. Of primary amputations there were five, three of which recovered, while two died-one from delirium tremens, the other from erysipelas and alcoholism. Of secondary amputation there were two cases. Both recovered.

Eighteen of these cases were treated in plaster-ofParis dressings-either by the bandage alone or else strengthened and assisted by brackets, as the cases seemed to require. Nine of these cases were put up in the permanent dressings at once, and nine