#) Author s Compliments. 
ij Chestnut Street, 
Beacon Hill, Boston, d/rts.s-. 
SOME MEDICO-LEGAL CASES 
UNDER STATE AND NATIONAL LAWS. 
By B. JOY JEFFRIES, A.M., M.l). 
OF BOSTON. 
From the Transactions of the American Ophthalmological Society, 
Twenty-Second Annual Meeting, 1S86. SOME MEDICO-LEGAL CASES UNDER STATE 
AND NATIONAL LAWS. 
By B. JOY JEFFRIES, M.D., 
BOSTON. 
In the Massachusetts Statutes, Chap. 194, as amended, is 
an Act relative to the employment by Railroad Companies of 
persons affected with Defective Sight or Color-Blindness, 
which reads as follows : 
Sect. i. No railroad company shall employ or keep in its employment 
any person in a position which requires him to distinguish form or color 
signals, unless such person has been examined for color-blindness or other 
defective sight, by some competent person employed and paid by the rail- 
road company, and has received a certificate that he is not disqualified for 
such position by color-blindness or other defective sight. 
Sect. 2. A railroad company shall be liable to a fine of one hundred 
dollars for each violation of the preceding section. 
The Act went in force July 1, 1881. Its wording was 
designedly made so as to defeat the purpose of a law protective 
to stockholder, employe and the community. It is practically 
as dead a letter as the liquor laws, as I recognized that it 
would be when passed. 
In my Infirmary and private practice, cases quite frequently 
occur illustrating the truth of the above statement. Many 
more must naturally occur in the practice of my colleagues. 
Attention should be called to them. The following cases are 
typical of those I have records of. Any member of the 
Society is liable to be summoned in court as witness or expert 
in connection with such cases, and under the gravest circum- 
stances, Jeffries: Some Medico-Legal Cases 
4 
No. i.—A young man wants to go on to one of two railroads. 
Vision of right eye = 2,(fff, of left eye normal with -j- U. 1.25, 
a lack of vision and a hypermetropia which should keep him 
from any position where glasses cannot be worn, which posi- 
tion he does not want. There is nothing to prevent “any 
competent examiner” giving him a certificate as engineer. 
No. 2.—A fireman at work on a road and desiring promo- 
tion to engineer, has converging strabismus. In right eye a 
hypermetropia of D. 2.50 and vision = fg, in the left, squinting, 
eye Hm. = D. 2.50 and vision — re- There being no legal 
standard set and no expert appointed to detect the hyperme- 
tropia, this man has readily passed such test as his road made. 
No. 3.—A brakeman has no certificate (the fine to the rail- 
road for this is one hundred dollars). He has 11m. = D. 1.50, 
V. O.D. = £&, O. S. = f J; requires -f- D. 2.50 to read. Without 
glasses he could not read an order or a telegram. 
No. 4.—A brakeman has been on a road some three years. 
Without glasses, V. O.D. = 76f, V. O.S. = V. O.D. with -f“ D. 
4.50= t62, V. O.S. with-f-D. 1.00 = The only test he had 
was the train despatcher asking him how many knobs there 
were on an adjacent telegraph pole, and telling him his vision 
was as good as any one on the road. 
No. 5.—A brakeman has been on three roads, only tested 
on one. He has convergent strabismus, great pain and marked 
symptoms of cerebral trouble. Only pain and fright keep 
him from his duty, from which he just comes. No law requires 
him to be off duty. 
No. 6.—A gateman applies to me for certificate for full 
pension for blindness contracted in the army. He groped his 
way into my office. He had white atrophy of optic nerve in 
each eye. He says at times he is completely blind in the sun, 
so he cannot see people on his crossing, which is an important 
one. He holds a certificate from his road examiner, “that he 
is not disqualified by defective sight.” 
No. 7.—An engineer comes from off his train with a foreign 
body on the cornea, requiring cocaine to remove, the “ boys ” 
having been at work on it. He refused atropine and cold 
As to the Form-sense. tinder State and National Laws. 
5 
compress, which were needed, and went back to his train to 
run some fifty miles. There was nothing to prevent him in 
his wholly unfit condition. Interference would only have 
provoked abuse. 
No. 8.—A similar case of a conductor, worse off, as it was 
before cocaine. 
No. 9.—An engineer has vision without glasses, O.D. = 
f£, O.S. = I8-; V. O.U. with -(- D. 1.25 = fg. Not color-blind. 
He was 52 years old, and his sight too poor for his position. 
Another employe testing him, of course certifies to him. 
No. 10.—A fireman, with vision normal and not color-blind, 
comes to be tested on his own idea, as he has never been 
tested or certified to by his road, where he has been some time. 
Road subject to one hundred dollars fine. 
No. 11.—Engineer, 56 years old, brought by his superin- 
tendent, is not color-blind, has vision O.U. = f&. The super- 
intendent was frightened and took him off his engine. • Under 
legal standard requirements and legal expert testing, this 
injustice could not have been done the man. 
No. 12.—A conductor has lost his place on an employe’s ex- 
amination. He is quite hypermetropic, easily corrected by 
glasses, which there is no objection to his wearing. Another 
injustice from want of legal standards of requirement and 
testing. On learning my name his abuse was profuse, though 
all my efforts have been to prevent such injustice to employes. 
Office seekers had falsely misled him. 
As to the Color-sense. 
No. i.—A gateman was turned off as color-blind. I found 
him only partially so. He never would have mistaken the 
lanterns in his hands. He had saved several lives at his 
crossing, was perfectly honest about his condition. The road 
examiner was afraid of certifying to him. Legal standards of 
color perception would have saved this injustice ; but it would 
have required an expert to test and certify to his usefulness. 
I would not have passed him as engineer. 
No. 2.—An engineer at work on a road I found perfectly 
color-blind. He was examined in the presence of the superin- 6 
Jeffries : Some Medico-Legal Cases 
tendcnt and his brother employes. The superintendent had 
spent a good many hours going over with me the whole sub- 
ject of defective vision practically, and declined to test his 
men himself. Neither he nor the employes would consent to 
this engineer being where he had to read colored signals. 
He was given a position in the shop, where he and the road 
made more money. His outside friends, who did not see the 
examination, carried him to another ophthalmic surgeon who, 
the superintendent told me, passed him as competent. T his 
did not, however, affect the superintendent’s decision, who 
said he would not employ him as engineer with any one’s cer- 
tificate. The certificate from the other surgeon would allow 
this dangerous man to be legally employed. 
No. 3.—A brakeman or fireman whose turn came soon after 
this engineer (No. 2) made all the characteristic mistakes of a 
color-blind with the three Holmgren tests. He was quite 
convinced himself that he was color-blind, and resigned to 
rejection. The superintendent and the other employes were 
equally convinced from their own observations of the man’s 
dangerous color-blindness. An experience with some thirty 
thousand examinations had, however, taught me, that whilst 
the man made the most thorough and characteristic mistakes 
of defective color-sense, he did not make them in the way the 
color-blind do. I first thought he was deceiving me and imi- 
tating the color-blind engineer preceding him. It proved 
that he had carefully watched and imitated him, not with the 
idea of deceiving, but because he supposed this engineer was 
right and all the normal eyed selections he had seen were 
defective. He would have been rejected on all other roads 
where no expert was employed; a legal injustice. 
No. 4.—An engineer whom I found incompletely color-blind 
was doubted, and no certificate given him by his road (rendered 
liable to $100.00 fine), although he was allowed to run. An 
accident happening frightened the officials, and his “boss” 
was telegraphed to let no one out that night without a certifi- 
cate. He having none was dropped. He would not have 
been under legal standards, from his term of service and suc- 
cess, or he could have been transferred to day work. under State and National Laws. 
7 
No. 5.—A master mechanic came to me for presbyopia and 
was found completely color-blind. His vision for form was 
remarkable, being equal to my own very nearly, 2S9. He describ- 
ed his utter inability to read the colored signals, having often 
watched them on the track with his little boy who could tell 
them at once. As master mechanic he hired all employes who 
had to read color-signals, and his decision would be final. This 
would be perfectly legal. 
No. 6.—An engineer is brought me by his superintendent 
and master mechanic. He was completely color-blind, even 
under such practical tests as they asked for. Till they had 
seen these a certificate from me would have, induced them to 
keep him at his work, where he relied wholly on guess and his 
fireman. My certificate would have been entirely legal. 
No. 7.—Another engineer brought at the same time was 
only a little less color-blind, and more dangerous on that very 
account. 
No. 8.—A conductor from same road applied to me for cer- 
tificate. He was completely color-blind. My certificate of 
usefulness would have reinstated him or placed him on another 
road, had I given one. 
I could not blame some of these and other employes who 
have been to me offering me the very heavy fees they did for 
a certificate. And I should have sympathy with a half-starved 
struggling physician yielding to the pecuniary pressure. It 
should be legally impossible by state laws or corporation regu- 
lations. Standard requirements and competent expert ex- 
aminers can alone insure honesty and fairness to all concerned. 
Under National Laws. 
The form-sense and the color-sense of officers and men 
entering the U. S. Army and Navy are tested, and a certain 
standard is required as to the visual power. For the navy 
and naval academy the restriction is naturally greater as to 
defective color-sense. So many cases of myopia, hyper- 
metropia and color-blindness have been before me in those 
desiring to enter army or navy that I wrote a letter on the 
subject to our local medical journal and sent an extra to our 8 
Jeffries : Some Medico-Legal Cases 
members. As it may not have been received, or thrown aside, 
I repeat it here : 
[From the Boston Medical and Surgical Journal, April 29, 1880.] 
Physical Examination of Candidates fok the United 
States Naval and Military Academies. 
Mr. Editor,—Members of Congress when having the right of 
nomination in their districts generally ask some physician to 
examine the young men who apply for the position. Such exami- 
nation includes that of the visual power and color-sense of the 
candidate. As only a certain amount of hypermetropia or of 
myopia will be passed by the United States medical examining 
boards and no degree of color-blindness by the naval medical board, 
it is pretty important that defective vision for form or color should 
be detected by the doctor certifying to the young man’s physical 
condition. 
It is more than mortifying to young men, who pass an excellent 
examination, to be afterwards thrown out for physical defects. 
Cases have applied to me, and I have heard of others, of excessive 
myopia and color-blindness, when months were wasted in prepar- 
ing for the ordeal, If the physician originally applied to cannot 
be sure of the degree of hypermetropia or myopia, it certainly 
would be better to send candidates to the nearest ophthalmic 
surgeon who can decide, than to have the young man rejected by 
the medical board afterwards. 
Defects of the color-sense may readily escape detection by 
methods of testing ordinarily used, as asking the names of colors, 
etc. The surest means is to apply Professor Holmgren’s test with 
the worsteds, as will be done to the candidates by the medical 
board. They, however, will have a proper collection of worsteds, 
but exactly the same can be procured of N. D. W’hitnev & Co., 
i29Tremont Street, Boston, with whom I arranged to keep on 
hand type collections, at the request of the American Ophthalmo- 
logical Society. 
Physicians have written to me from different parts of the country 
complaining of their utter inability to apply Holmgren’s test as 
described in my manual. On investigation I have found that 
they did not have a proper set of worsteds, but some of the imita- 
tions advertised and sold in New York and Philadelphia. An 
examination of these imitations showed that they could not pos- 
sibly be used to properly carry out Holmgren’s test. I hasten to 
say that I have no pecuniary interest in Mr. Whitney’s sale of 
worsteds. I am desirous that the now necessary application of 
Holmgren’s brilliant invention should not be interfered with by 
tradesmen’s ignorance or cupidity, and that physicians should not 
be imposed on. 
Yours truly, B. Joy Jeffries, M.D. 
15 Chestnut St., Boston, 
April ao, 1886. under State and National Laws. 
9 
The report of an international signal commission, awaited 
by other maritime nations, can under present conditions and 
recent acts of Congress be made at once applicable and en- 
forced. Only such can possibly contend against outside pres- 
sure and neglected duty in the interest of the dangerously 
defective. 
No. i.—A young man has passed a physician’s inspection, 
goes up for examination for West Point, passes mentally bril- 
liantly, but is rejected for vision only one-fourth, from myopia, 
likely to increase. This my testing confirmed. The loss of 
time and mortification were needlessly incurred. 
No. 2.—A very parallel case came in a would-be naval 
cadet. 
No. 3.—I was applied to by a young man who had passed 
an excellent mental and physical examination to enter the 
naval academy, with the exception that the medical board re- 
jected him as color-blind. A special order of the Secretary of 
the Navy granted him another color examination. He pur- 
chased a set of Holmgren’s worsteds, my color chart for 
educating the normal color-sense in the schools, and finally 
wrote me that his mother had cured him by education. I 
have do doubt that outside pressure might put him into Anna- 
polis against the medical board’s protest. The agreements 
made by an international signal commission would alone pre- 
vent any such pressure. It would force medical officers to be 
more certain by being more thoroughly posted, and render 
their decision final. 
No. 4.—A naval officer completely color-blind has gone on 
the black retired list, from lack of international standards to 
protect him. 
In the revenue marine, officers and men are tested and some 
standard applied under the marine hospital service. In the 
merchant marine, masters, mates and seamen may be blind 
and color-blind; there is no law touching them. Pilots may 
be blind, and no test is required of their form perception. 
They are tested for color-blindness and rejected if the examin- 
ing surgeon declares them defective, or allowed only day routes. 
If he says partially defective, the local inspectors of steam 10 
Jeffries : Sonic Medico-Legal Cases 
vessels may pass them, no matter how dangerous they are, as 
proved. The adoption of the necessary report of an inter- 
national signal commission can alone insure the requisite 
knowledge on the part of the medical officers and prevent any 
and all interference with their decision, which decision would 
be guided by internationally agreed standards, etc. 
No. i.—The results of the examination of a pilot are re- 
ferred to me from Washington for decision. The report of 
the medical board, etc. I reply, that without personal exami- 
nation of the candidate I could not fairly decide. The officers 
could have been readily taught so as not to have been in 
doubt. It must, however, be remembered that every sort of 
outside and inside pressure has been employed to prevent 
any examinations or rejections by medical officers. 
No. 2.—A captain who desired a pilot’s license was declared 
color-blind by the marine hospital surgeon. The local in- 
spectors doubted it and advised appeal to me. I found he 
had normal form and color-sense. As I had induced the law, 
and he was my patient, I felt it my special duty to have him 
get his license. Upon proper inquiry I found that the medical 
man was an acting surgeon awaiting promotion, who had not 
studied my manual placed by the government in his hands and 
had a poor and insufficient collection of worsteds, which he did 
not realize. He had fallen into the usual error of asking the 
man the names of colors, and got him as mixed as himself. I 
reported the case to Washington, it was referred to other 
marine hospital surgeons to consult with me, and I readily 
showed the mistake* and the man soon had a pilot’s license. 
No. 3.—A captain acted as pilot on an important route. 
When the law was enforced the marine hospital surgeon found 
him completely color-blind, and he was rejected. All sorts of 
pressure was made, as in other cases. He appealed to the 
Treasury Department over the Inspectors, and the following 
letter is printed in their report: 
Treasury Department, November 5, 1880. 
Sir,—The Department has received your letter of the 2Sth, in 
which you ask that having been rejected in your examination for 
a pilot’s license on account of color-blindness, you may be accorded under State and National Laws. 
11 
a second examination by the local inspectors. In reply, you are 
informed that if your case comes within the provisions ol Depart- 
ment Circular, No. 46, 1880, a copy of which is herewith enclosed, 
you are entitled to appear before the local inspectors at Boston 
for re-examination without appeal to the Department. Otherwise, 
the Department is not disposed to make further modification of the 
regulations upon this subject. Very Respectfully, 
J. H. Upton, 
Acting Sec. 
In order to yield to the outside pressure and prevent the 
discharge or refusal of color-blind pilots, a rule was made that 
if the surgeon said the man was partially color-blind he could 
be referred to the local inspectors. These always passed 
him, their tests being as silly as ignorant. 
A patient of mine who was a friend of this pilot, after his 
appeal, etc., brought him to me, and the very practical tests 
applied, quickly induced the friend to advise the pilot to give it 
up. This the pilot could not see. Some three years afterwards 
the former employer of this pilot brought him to me again to 
test. I explained his case, the department action, etc., but 
was met by the exhibition of his license in due form. This 
his employer did not care for, but wanted personally to see 
what was the trouble, etc., as he would run no risk on his 
steamers. The same practical tests, such as a colored side light 
held in the sun six feet before the pilot’s face and not recog- 
nized, soon convinced the employer as it had the friend. On 
inquiry I found another marine hospital surgeon had tested 
the pilot and called him partially color-blind, which enabled 
the inspectors to pass him by their tests. They did not even 
limit him to day work. Their records give him a full license. 
Comment is hardly necessary. How many more are there ? 
The Society will recognize that any of these cases might 
have come under their observation, and that under the gravest 
conditions of danger to life and property. I would recom- 
mend caution and attention.