whether you have done in this case, or in that case, the thing that is right or the thing that is wrong? What is the effect, I say, upon the character and welfare of your company of those two different courses of action? Whether the claim agent, on the one hand, exacts the last farthing possible for his company, or, on the other hand, approaches every case and settles it with a beneficent purpose, not only to serve his company loyally, but to do justice to the injured party? We have had warnings of these different courses of procedure and we need no dissertation nor historical description of Company "A" or Company "B" or Company "C" to advise us what will be the result, if we follow one or the other of these courses of procedure. The representatives of railway companies are known to be identified with power, with wealth and with great influence, and no man can be in the service of a railway company, at least in America, without being recognized as a man who is fortunate in some sense in being allied with a railroad company; therefore, the representative of a railway company is a mark for observation and criticism in the community where he lives. He stands in that respect a little different from other men. Now, what is the result? Suppose a claim agent follows the course first indicated, and in the course of his business is invariably harsh and pitiless, and extorts the lowest settlement possible out of a mutilated person or the representatives of one who has been killed? conceals facts that he knows are against his company, sometimes perverts and falsifies those facts, and is willing to deceive and impose upon an ignorant person, in order to save a little money for his company.' He may save a few dollars in one case, but the party who has been injured, and afterward wronged, does not keep that fact to himself. His neighbors want. to know what treatment he has received from the railroad company for the loss of an arm, or whatever his injury may be. So that there are many people in a community who know at once what the railroad company has done for the man. Now, it is not long before that claim agent has to settle with somebody else. If the means of communication are not very good, it is possible that the next man he has to deal with may not have heard of the case described and he, too, may be duped and cheated by the claim agent, but presently af

He

fairs come to that state where everybody knows that that particular claim agent is an unscrupulous man, and when anybody is injured and is asking about where he can get. advice and to whom he can go in his trouble, he will be told: "You cannot trust yourself with that claim agent; you had better get a lawyer, get somebody who is a match for him and let him sue the company." So that in time the claim agent acquires an unsavory reputation, and, unfortunately, at the same time he is bringing his railroad company into disrepute, because the public do not discriminate between the corporation and the acts of its representative. So that under such a course of procedure, it is not long before the whole community comes to look upon that claim agent and the company which he represents as unprincipled, grasping and despotic.

Now what is the effect of such conduct? We have seen what is in juries; we have seen what is is on boards having power of taxation; we have seen what it is in legislatures, and even in Congress. In other words, there is not a department of the administration of public affairs into which the knowledge does not come of the character of a railroad company and its employes. It may be that the injured party himself may some day sit upon a jury in a case in which a railroad company is involved, or on a taxing board, in the legislature or in Congress; or, if not a member or judicial officer himself, he is sitting on his portico some night and talking with his neighbor, or is in one of the offices in the county building, and there, in the presence of the sheriff or the clerk, or some of the county officers, he is relating his own experience, or that of John Smith, in getting a settlement with the railroad company for the loss of his arm. He tells his story and the railroad company is not there to defend itself, even if there was a defense to be made, and there goes forth into the heart of every man who listens to that tale a feeling of resentment against that railroad company, not merely against the unscrupulous claim agent, but against the company which he represents, and then woe betide the company when the man who has heard that story is on a jury or on a taxing board, or in the legislature, when the interests of that railroad company are at stake.

I have seen the operation of cases of that

kind in multiplied instances, and I have seen the evil consequences of them; I have also been permitted to see the very reverse, where the representatives of a railroad company, recognizing, in a particular case, that the company is in the wrong, do the very thing which one neighbor does toward another neighbor when he has wronged him. He feels that it is just for him to repair that wrong, and he does repair it as far as he can. He recognizes the duty that rests upon his company, as well as the good policy of the act, to seek to do justice to the man with whom he deals; and in that way he protects his company from bad repute. While the growth of opinion and the growth of character is often slow-it is sometimes disheartening that it is so slow-yet, ultimately that railroad company, through the aid of that honorable man who represents it in the claim department, may feel just as sure of honorable recognition and of fair treatment in the community where the railroad company's interests are under public consideration as any private citizen. Therefore, I say that the welfare of the railroad company is promoted by your exercising the sentiment of justice in your dealings with every injured

man.

Try to do as near as you can what your conscience tells you is right, and I will trust your conscience in every case, and, further than that, I will trust the officers of the railroad company to sustain you.

There are swindlers abroad in the land, and no men know it better than claim agents. There is no class of men, unless it be hired detectives, who have presented to them as many phases of duplicity in human nature as the claim agents of railroad companies. So that when we come to consider the mental characteristics which the claim agent should have, I reckon among the very first the power of penetration that enables him to look into a man's face, to weigh his words and determine whether he is a swindler or whether he is an honest man. The impressions he receives are sometimes erroneous, especially so if they are received too hastily. You are not called upon to decide a case the first minute, nor the first day, nor the first week after you have had an interview with the person who says he has been injured. In cases of alleged nervous prostration, injury to the spine and other favorite ills of swindlers, where you cannot see

that a leg or an arm has been broken; or where a man says he has an indescribable sensation and cannot tell you what it is, cannot tell because he hasn't anything of the kind; in such cases take your time to decide the claimant's sincerity and be diligent in hunting up his record. You will soon have intelligence to enable you to distinguish between fact and fraud, and, when sure of your point, act according to the merits of the case. Give not a cent to the swindler, and if he has swindled you, follow him till the prison gates close upon him. But if he is honest and has really been injured and is reasonable in his demands, your heart will tell your mind how you should act. Do by him as you would like to be done by in similar circumstances. I know of no safer rule in dealing with an honest man than to apply the Golden Rule, and do unto men “as you would that they should do unto you." It sometimes seems trivial, some may think it seems unmanly, to refer too often to the Golden Rule. We learned that rule at our mother's knee, we learned it when we were children and when the question at issue was about the division of a piece of cake or an apple, a few chestnuts or a little candy. I have been working pretty busily all my life, and I am ready to make the confession now and here, at the risk of being considered a weak-minded man, that I know of no safer guide on earth, in the largest as well as in the smallest transactions, than the Golden Rule; it is good for great men as well as for little children.

Now, then, what other faculties are you called upon to exercise in the consideration of claims? Not only penetration, which enables you to distinguish between truth and falsehood; not only patience in the investigation of facts, and diligence in collecting all of them, but a sound judgment, a saving common sense of what is proper to do in any particular case. Entirely apart from the question of loyalty to your company or justice to the man with whom you are dealing, there are always circumstances that call for the exercise of a wise judgment; having determined what is just in this matter, and having every variety of men to deal with, I know of no place where a sound judgment can be exercised with such fruitful results to a railroad company as by a claim agent, in determining whether he had better settle or stand a lawsuit, just how far

he will go to secure a settlement, and where he will stop and allow his company to be sued, rather than be wronged. Here is a faculty which no man can say he was born to; it is the wisdom which comes of understanding, and experience gathered year by year, which ripens his judgment, so to speak, just as years of sunshine and showers ripen and develop the tree until it grows to a state of perfection. A man's mind is subject to influences, just as the creations of nature are. He receives impressions; he acts on them wisely and profits by them, or he acts on them unwisely and suffers by them. If he be heedful of his steps, if he learns to reflect and ponder upon his experience, to consider when and why he made mistakes, and when and why he acted wisely, these reflections will educate his judgment and make him a wise man; and just to the extent that he has thus educated his judgment and perfected his wisdom he will be able to draw the threads of what is fit and fair in every case which comes before him.

I have mentioned, briefly, as I am compelled to do, what I look upon as the fundamental requisites of a successful claim agent, not only with reference to his success as a claim agent, but with reference to the welfare of the company he serves. The recapitulate, therefore, I think that the conduct of the claim agent should be guided by a sentiment of loyalty to his company, and of justice to his fellow men. He should feel that he is working, not simply for to-day, but for all time. The reputation, the standing of the railway company he serves will survive him many, many years, and I would like to see every member of this association recognize, with me, the fact that the character, the reputation, the prosperity of his company, not merely in his own day, but with generations who are to follow him, will depend largely upon the manner in which he performs the duties of the present day and hour.

Finally, how can these traits of mind and heart be sharpened, quickened, broadened and strengthened? In considering this branch of the question I have mentioned but one or two points, advising that you make careful observation of your own conduct, note down in your own heart, you need not tell the world about it, but make a note of it in your own heart and for your own benefit, whether the

claim which you settled yesterday was settled equitably or unjustly. If you have done well, that act has the approval of your conscience. Now, then, by keeping that sort of a mental and moral diary of your own transactions, your mind becomes quickened and broadened, your conscience is strengthened and educated, and day by day you become better qualified to serve your company and add to your own reputation, and when Nature calls you away you leave your company in higher standing, with better credit and a better character than it had when you began to serve it, or than it would have had if you had pursued a different policy. Serving it, therefore, with an enlightened moral sense, and with an intelligence which has been educated by these mental observations which you make upon yourself and record in the diary of your mind and the diary of your heart, I say you are qualified to produce the best results for your company, not only in the day and generation in which you live, but in the far distant future, whose limit it is not given us to discern.

Now, gentlemen, I am conscious that I have given but an outline of what might be said, and I would be glad to talk with you longer, but, unfortunately, my time is limited and I know that yours is; and so, welcoming you to this city and deriving the highest pleasure in the motive which draws you together, and in your desire to make the best of yourselves and your duty and your position, and to exalt yourselves and your office and the companies with which you are associated, urging upon you the necessity and propriety of coming together often, comparing notes and giving each other the benefit of your individual experience, what you have learned and what you have done, I thank you for the attention you have given

me.

A violent temperance advocate, upon being ushered into the dining-room of a friend, found. the host and another guest just in the act of discussing a brace of roast ducks, with a bowl. of punch in the background. He was asked to join them. "No, no, gentlemen," was the reply. "Give me a glass of water and a crust. You know not what you are doing. You are digging your graves with your teeth." Both gentlemen, however, outlived him.

FIVE CASES OF DISLOCATION AND FRACTURE OF THE SHOULDER.*

BY HOWARD J. WILLIAMS, A. M., M. D., MACON, GA.

These five cases, two of simple fracture of the humerus near the shoulder-joint, two of dislocation and one of fracture and dislocation, have come under my observation during the past seven months. They are reported simply to call attention to the necessity of early diagnosis, prompt reduction and careful after

treatment:

Case I: J. S., male, 25 years old, white, machinist, had his left shoulder dislocated in a wreck on August 30, 1895. The dislocation was of the sub-coracoid variety and was promptly reduced without the aid of an anæsthetic at the scene of the wreck. Upon reaching his home he placed himself under the care of his own physician, who kept the arm bound to his chest for a month, without passive motion. Three months later he was sent to Dr. McHatton and myself because of limitation of motion in the shoulder-joint. He could not raise his arm to a right angle from the body and could not place his hand upon his head. Ether was administered and the adhesions about the joint broken up. Anodyne lotions and daily passive motion were ordered, with recovery of a large part of the use of the joint.

Case II: W. M., male, 22 years of age, negro, porter on a Pullman car, had his right shoulder dislocated (sub-coracoid) in a wreck, February 29, 1896. I reduced the dislocation under the influence of chloroform at the scene of the wreck and placed temporary dressings on the arm and body.

The patient was sent to the hospital and placed under the charge of Dr. McHatton, March 1, 1896, and early passive motion instituted. Recovery followed with no loss of motion in the joint.

Case III: E. F., male, aged 48, white, engineer, had his left shoulder dislocated and the humerus fractured near the joint, in a wreck in December, 1895. Under chloroform, the dislocation was reduced and the fracture adjusted by Dr. McHatton and myself at the wreck. He was admitted to the hospital and kept under close observation for two weeks,

*Read before the Central of Georgia Railway Surgeons' Association, Augusta, Ga., April 14, 1896.

early passive motion being instituted. He was then transferred to his home at Rome, Ga., and was under the charge of his family physician. The dressings put on him before he left the hospital were undisturbed for three weeks. When they were finally taken off he had only slight motion and could not carry the arm six inches from the side of his body and could not move the arm forward or backward at all.

March 16, 1896, he was returned to us for treatment. He was chloroformed and by violent manipulation the strong fibrous adhesions about the joint were broken up. Daily passive motion, massage and electricity were used. The deltoid and other muscles about the joint were wasted by non-use. He remained under treatment in the hospital for seven weeks. Once every ten days chloroform was administered and vigorous passive motion used. He then could carry his arm outward by his own effort to an angle of 45 degrees, and had recovered nearly the entire forward and backward motion. Under the anæsthetic his hand could be placed upon the top of his head and the arm carried nearly vertically above the joint. He will never recover the complete use of the joint, but will in time regain much of the voluntary use of the limb. Case IV: D. C., female, 75 years old, negro, laundress, fell on the pavement on March 1, 1896. March 6 she sent for me, and finding the arm and shoulder swollen, painful and deformed, I suspected either fracture or dislocation. I had her sent to the hospital at once. Her general health was good, but she had a very marked arcus senilis. The urine was examined with the following result: sp. gr. 1020, no albumen, no sugar.

On March 7 chloroform was administered and a fracture of the humerus just above the surgical neck was discovered. Splints were applied. At the end of the second week gentle passive motion was used. The forearm and hand were badly swollen and painful, and there was pain in the scapular region.

Again, at the end of the next week, passive motion was used. Owing to her extreme age we cannot say what will be the final outcome of the case, but hope to recover considerable motion.*

*May 23. since reporting the above before the association, I regret to say that while she has some motion in the joint, it is painful, the swelling of the forearm is still present and there is some deformity left about the shoulder.

Case V: A. W., male, 51 years old, a negro laborer, fell out of the door of his house, September 19, 1895, producing some injury to the left shoulder. On September 22, 1895, he was admitted to the hospital and, in addition to his injury, it was found that he was suffering with advanced Bright's disease, feet and legs oedematous, insomnia, hiccough, obstinate diarrhoea, urine largely increased in quantity, sp. gr. 1014, slight trace of albumen and tube casts. The shoulder was swollen and painful. Chloroform was carefully administered and a fracture very high up was found, which we thought to be in the anatomical neck. Dressings were applied.

His diarrhoea could not be controlled, the hiccough persisted and at the end of the second week coma developed. He died three days later.

The shoulder-joint was opened after death and the head of the humerus, with two inches of the shaft, removed (specimen exhibited). It will be seen that the fracture is just half an inch below the anatomical neck and transverse in direction, and it will further be seen that there is a split running into the anatomical neck. There is a natural groove on the upper and outer part of the anatomical neck in all bones, but in this case the split is deeper, and by a little manipulation is can be made to open. This case came very near being comminuted or impacted. The cancellous tissue of this bone is very thin and friable. This is the highest fracture I have seen post-mortem. It was not intracapsular. Fracture of the anatomical neck is doubted by some authorities, but Gross and others record cases.

As the shoulder-joint is the most important joint, particularly to the laboring man, we should be extremely careful to make an early diagnosis of all injuries, using an anesthetic if in doubt. If swelling has occurred an anæsthetic should always be employed. As soon as discovered, measures to reduce the deformity should be instituted; no delay should be allowed. When there is a combination of the two injuries, fracture and dislocation, without an external wound, if there is great difficulty or impossibility of reducing the dislocation and adjusting the fractured ends of the bone, an incision, under antisepticism, should be made and the deformity corrected by mechanical means rather than allow the functions of

the shoulder to be lost. After-treatment to prevent inflammation should be used. Rest is the first indication, followed by cooling lotions to the injured parts, but rest should not be carried too far. It will be seen that in two of my cases this occurred. The joint was allowed to remain bandaged for three weeks in one case and for one month in the other. Early passive motion should be instituted in all injuries of this joint to prevent faulty adhesions and restore the usefulness of the joint. In the case of the old colored woman, I think the bone was comminuted and her age was against successful repair of fractured bones. We used passive motion but failed to recover much use of the joint.

SHOULD WE HAVE PUS IN RAILWAY SURGERY?*

BY LESTER KELLER, M. D., IRONTON, OHIO.

One to whom the above question is put would most likely answer-yes, if we have it anywhere. We formerly had it in almost all kinds of cases, we sometimes have it now, but it surely should be a rare thing where we have control of our patient from the start.

We look with awe upon a man who speaks with authority, but when we get in a meditative mood we sometimes wonder whether even he might not be mistaken. Our Railway Surgeon, that contains so many good things and is supposed to be the beacon light for the way-station railway surgeon, sometimes contains things that make us sit down and think: "How different from the results we have been trying to obtain!" And we wonder whether the editor really means it-whether it is really

So.

From an editorial in the issue of November 5, 1895, we take the following: "While the presence of pus may be lacking in a great majority of operative cases, yet in accidental surgery its presence is the rule, and its entire absence is a marked exception. Again, it will be noticed that it is almost as universal an attendant as it was prior to the introduction of antiseptics. Even in amputations, necessitated in consequence of the crushing of limbs by ponderous wheels, particularly when the inferior extremity is involved, under the strictest

*Read by title at the ninth annual convention of the National Association of Railway Surgeons, at St. Louis, Mo., May 1, 1896.