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Traumatic Neurasthenia.

At a recent meeting of the New York Neurological Society Dr. C. E. Nammack presented a patient, a policeman, who, on October 12, 1892, had attempted to stop three runaway horses, attached to a steam fire engine, in the Centennial parade. He was successful in this, but although not physically injured, he received a profound psychic shock. One week later it became necessary for him to seek medical advice, for the relief of pains in his chest. On the advice of Dr. C. L. Dana he went abroad, and remained there from June, 1894, to October, 1895. He had been perfectly well up to the time of this accident, and his family and personal history were excellent. He remained on police duty for some time, but found himself unable to attend to his work, even though his promotion to the rank of roundsman had rendered this less monotonous than formerly. The first symptoms noticed were diminished power of persistent application and nervous irritability. Mental exaltation then became marked, and insomnia became most distressing. Hyperæsthesia and paræsthesia were noticed. The principal subjective symptoms were pain over the heart and dyspnoea, on exertion; profuse sweating and insomnia. Examination recently showed the pain and temperature senses normal, tactile sensibility impaired, and hyperæsthesia wanting. Both visual fields showed the shifting type of contraction. Color perception was fairly good. There was no motor weakness of the eyes and no abnormal pupillary reaction. Smell and taste were not affected; station and gait were good; there was some tremor of the hands. The knee jerks were slightly exaggerated. The heart action was weak and greatly accelerated by walking; there was no enlargement of the heart or valvular disease. Slight irritation of the skin led to persistent redness. His weight had fallen from 220 to 175 pounds. Micturition was not vigorously performed. The urine was normal. The sexual desire was weak, although the power was good. The diagnosis in this case, the speaker said, lay between traumatic neurasthenia, traumatic hysteria. and simulation. The last was excluded by the absence of motive, of striking symptoms and of efforts to exaggerate slight symptoms. Hysteria was excluded by the absence of anæsthesia, contractures, spasms, etc., and of paroxysmal phenomena. The patient had had the benefit of skilful treatment, and improvement had been slow but steady. Apparently, hydro therapy had benefited the

patient the most. The case was interesting, as being free from the usual complications arising from prospective lawsuits.

Dr. C. L. Dana said that when he saw this case he made the diagnosis of traumatic neurasthenia. The case was an interesting and typical one, and was chiefly of importance on account of the absence of the complications referred to.

Dr. Nammack, in closing, said that formerly considerable stress had been laid upon the condition of the visual fields as a differential point between traumatic neurasthenia and hysteria, but that now this had been pretty much abandoned.-Journal of Nervous and Mental Diseases.

Roentgen Rays in Internal Medicine.

Huber, of Leyden's clinic (Deut. med. Woch., March 19, 1896), remarks that in various swellings of the joints it may be impossible to ascertain by palpation whether the changes lie in the joint ends, in the cartilages, or in the soft parts. Case I: A man, aged 31, had a third attack of rheumatism. He had also had several attacks of gonorrhoea, from one of which he was still suffering. The photograph showed distinctly the swelling of the soft parts about the metacarpo-phalangeal joints of the middle and index fingers, and also about the first phalangeal joints of the second and especially the third fingers. No change was visible in the bones. Case II: A woman, aged 41, had suffered from chronic rheumatism for two years. At first it was limited to the small joints of the hands; later the elbow, shoulder, knee and ankle-joints were affected. Here the photograph showed that, although the rheumatism had existed for two years, there were no anatomical changes in the bones of the hands. Under treatment she improved considerably. Case III: A man, aged 49, had suffered for three or four years from painful swellings in the fingers, due to gout. The photograph showed lateral outgrowths and irregular thickenings in the ends of the bones. In the terminal phalanges a streaky appearance was visible, due in all probability to the deposit of lime salts. Case IV: A girl who had a poisoned wound of her hand three months previously. had a thickening about and loss of movement in the first phalangeal joint. The photograph explained the failure of past methods of treatment and the need of surgical assistance. The last photograph was from a patient who had suffered from gout for thirtyeight years previously. It showed (a) large gouty nodules beneath the skin, and apparently in connection with the joints. These deposits of uric acid allow the rays to pass through fairly well. (b) Great changes and destruction in the joints, and (c) destruction of the bone.

In the terminal phalanx of the ring finger it would appear as if there were a cavity surrounded by a thin wall only, the cavity being probably filled with uric acid. The removal of the uric acid in this case, either by absorption or otherwise, could only render a hitherto useful hand quite useless.-British Medical Journal.

The Fees of Medical Witnesses in Great Britain.

In Scotland, medical witnesses receive two guineas for each day they are cited to appear in the circuit court of the town in which they are residing and three guineas if the court is held at a distance. There are also allowances for traveling and other expenses. In England and Wales the fee is one guinea per diem, one round trip railway fare, and an allowance of two shillings per night. If the court is held in the city in which the witness resides, there are no allowances beyond the guinea a day. The association of police surgeons of Great Britain and Ireland is agitating the question of demanding larger fees for witnesses. It recently requested the home secretary to receive a delegation to confer with him on the desirability of revising and increasing the present scale of fees, but he declined to discuss the question, seeming to think that $5 a day was good enough pay for a docter.-Medical Record.

One of the interesting characters of the fourteenth century was the sergeant surgeon of Edward III., in 1346, John of Arden. He gives a "Description of ye qualites which ought to be in ye surgeon that performeth any operation in chirurgery:

"First, that he be devout. Secondlie, charitable to ye poor. Thirdly, to use few words. Fourthly, to avoid drunkenness. Fifthly, to be chaste both in words and gestures, as well as to fear ye not.

Sixthly, not to undertake an incurable disease."-Medical News.

We have received the following from the secretary of the Marion-Sims College of Medicine of St. Louis: Whereas, Dr. I. N. Love

has found it incumbent on him to sever his connection with the Marion-Sims College of Medicine, the members of the faculty of that institution embrace this occasion to express their appreciation of his past services, and to extend to him their hope that in all his future connections he will find both pleasure and profit.

C. Barek.

R. C. Atkinson.
B. M. Hypes.


Notices and Reviews.

Obstetric Accidents, Emergencies and Operations. By L. Ch. Boisliniere, A. M., M. D., LL. D., Philadelphia: W. B. Saunders, 1896.

The author sets forth in his preface that "this book is not a treatise on midwifery nor a manual of obstetrics," but that "it is intended for the use of the practitioner, who, when away from home, has not the opportunity of consulting a library or of calling a friend in consultation." The work is far from being what the author intended. In the first place, it contains too much that belongs more properly to a treatise or manual, and which would be of little value or interest to one seeking help in an emergency. This unnecessary padding makes the volume too bulky to be conveniently used as a working guide. On the other hand, to one requiring assistance, when away from library and friends, the book would prove, in most instances, a disappointment. There is a serious lack of explicitness in giving the details of treatment, whether operative or otherwise, and the author's meaning is not always clear. The avowed object of the work is lost sight of at times, as, for instance, when the writer insists that where surgical anææsthesia is necessary "chloroform must be administered by a reliable medical assistant," and when he urges that in all bloody operations one or two able colleagues be called in consultation. In the treatment of abortion one is advised to do nothing aside from the use of ergot and the tampon, until "bad symptoms" show themselves, because under certain conditions the ovum or placenta may be retained for months or years without danger. According to the author, incomplete perineal lacerations, that is, those beginning at the vulva and not involving the anal splincter, "do not require any particular treatment, as they heal spontaneously," which is quite at variance with the teachings of the majority of obstetricians. The author emphatically declares that the killing of an unborn child, in order to save the mother's life, is never justifiable, at any stage of uterogestation. He deplores the wanton "slaughter of the innocents" in cases of uncontrolable vomiting of pregnancy, and in cases of tribal or abdominal gestation.

The book is well printed and is profusely illustrated, to a large extent with Dr. Dickin

son's beautiful cuts, reproduced from the American Text Book of Obstetrics.

L. H. P.


"The Technics of the Trial Case; or, Subjective Optemetry," by A. Edward Davis, A. M., M. D. Reprinted from the New York Medical Journal for June 20, 1896.

"Fetal Hiccough," by Jos. B. DeLee, M. D. Reprinted from The Chicago Medical Recorder, August, 1895.

"Three Clinical Obstetrical Studies," by Jos. B. DeLee, M. D. Reprinted from The Chicago Medical Recorder, May, 1896.

"Salivary Calculi," by Gustav Fütterer, M. D. Reprinted from Medicine. Geo. S. Davis, publisher, July, 1896.

"A New Method of Treating Pneumothorax," by Gustav Fütterer, M. D. Reprinted from Medicine, June, 1896.

"Sponge Grafting in the Orbit for Support of Artificial Eye," by E. Oliver Belt, M. D., of Washington, D. C. Reprinted from The Medical News, June 27, 1896.

"The Diagnosis of Hysteria," by Hugh T. Patrick, M. D. Reprinted from the New York Medical Journal for February 15 and 22, 1896.

"The Conservative Use of the Stomach Tube in the Treatment of Gastric Diseases," by J. M. G. Carter, M. D. Reprinted from the Journal of the American Medical Association, June 15, 1895.

"Is the Disturbed Equilibrium of the Eye Muscles a Cause of Headaches and Other Reflex Neurosis?" by F. C. Hotz, M. D. Reprinted from the Chicago Medical Recorder, April, 1896.

"Ulcer of the Stomach," by J. M. G. Carter, M. D., Waukegan, Ill. Reprinted from International Clinics, Vol. IV, Fifth Series.

"Conservative Surgical Treatment of Para and Peri-Uterine Septic Diseases," by Fernand Henrotin, M. D. Reprinted from the American Gynæcological and Obstetrical Journal for June, 1895.

"Hypnotism," by Hugh T. Patrick, M. D. Reprinted from International Clinics, Vol. IV, Fifth Series.

"Sarcoma of the Choroid, Glioma of the Retina, and New Formed Blood Vessels in the Vitreous," by L. Webster Fox, M. D. Reprint from the Ophthalmic Record, Vol. 5, No. 8.

"Hydro-Galvanism of the Urethra," by Robert Newman, M. D., New York. Reprinted from Transactions of Electro-Therapeutic Association, 1895.

"The Extension Corset and Its Indications," by Alex. C. Wiener, M. D. Reprinted from

the Journal of the American Medical Association, April 25, 1896.

"Present Status of Operative Treatment for Bladder-Stone," by Arthur Dean Bevan, M. D. Reprinted from Medicine, May, 1896.

"The Development of the Test Card," by Dr. Frederick K. Smith. Reprinted from the Cleveland Medical Gazette, June, 1896.

"Diagnosis of Hystero-Epilepsy," by Hugh T. Patrick, M. D. Reprinted from the North American Practitioner, July, 1896.

"The Experience of Several Physicians with Sero-Therapy in Tuberculosis," by Paul Paquin, M. D. Reprinted from the Journal of the American Medical Association, August 15, 1896.

"Tumors of the Eyeball," by William H. Wilder, M. D. Reprinted from the Journal of the American Medical Association, April 27, 1895.

"Paralysis of the Ocular Muscles," by William H. Wilder, M. D. Reprinted from the Chicago Medical Recorder, July, 1896.

A physician is an angel when employed, but a devil when one must pay him.-German.

I had reasoned myself into an opinion that the use of physicians, unless in some acute disease, was a venture, and that their greatest practicers practiced least upon themselves.Sir W. Temple.


PRACTICE FOR SALE:-I offer for sale my practice in the county seat of one of the best counties in Iowa. Have been here for twelve years; am surgeon of the leading road entering the town; am medical examiner for six life insurance companies, etc. I simply require that my successor buy my office fixtures, mostly new-worth $700. Purchaser must be reliable. physician with few years' practice. Address "Z. V.," care RAILWAY SURGEON, Chicago.

Desiring to remove to the Pacific Coast, I offer my well-established practice of over 20 years to any physician who will purchase my real estate, situated in one of the most beautiful and thriving towns in Southern Michigan, and surrounded by a very rich farming country. The town is intersected by two important railroads, for one of which the subscriber is surgeon. The real estate consists of a fine brick house of eight rooms and two fine offices besides, attached to, and a part of, the residence. A fine well of the purest water, two cisterns, waterworks, etc. Fine garden filled with choice fruit in bearing, peaches, pears and apricots and small fruits, raspberries, currants, etc. Fine barn and other outbuildings, comparatively new and in the very best condition, all offered with the practice and goodwill at a very low figure for cash. Address MACK, Surgeon," care RAILWAY SURGEON, Monadnock Block Chicago, Ill.

By reason of failing health, physician wishes to dispose of real estate and practice. Practice amounts to nearly $4,000 per year. No charges except for real estate. Address WM. D. B. AINEY, Montrose, Pa.

Desiring to remove to a warmer climate, owing to poor health. I offer my well-established practice of 11 years to any physician who will purchase my real estate; situated in one of the most thriving towns in the Platte Valley, in Central Nebraska, on main line of Union Pacific R. R., on which road I am the assistant surgeon.

The real estate consists of 2 lots "on corner," on which there is a fine artistic "modern" frame house, 8 rooms; stable 20x30, wind mill, tower and 30-barrel tank; nice blue grass lawn, trees and fine garden (all new); and all offered with my $5,000 practice and good will, at a very low figure. A part cash, balance on time. A very thickly populated country. Address BOVINE, care RAILWAY SURGEON, Monadnock Block, Chicago, Ill

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F. J. LUTZ, St. Louis, Mo.
First Vice-President. W. R. HAMILTON, Pittsburgh, Pa.
Second Vice President... ..J. H. LETCHER. Henderson, Ky.
Third Vice-President..... ..JOHN L. EDDY, Olean, N. Y.
Fourth Vice-President....J. A. HUTCHINSON, Montreal, Canada
Fifth Vice-President.. .A. C. WEDGE, Albert Lea, Minn.
Sixth Vice-President.. RHETT GOODE, Mobile, Ala.
Seventh Vice-President...E. W. LEE, Omaha, Neb.

C. D. WESCOTT, Chicago, Ill.
..E. R. LEWIS, Kansas City, Mo.
Executive Committee:-A. I. BOUFFLEUR, Chicago, Ill., Chair-


J.N. JACKSON, Kansas City, Mo.; JAS. A. DUNCAN, Toledo, 0.; J. B. MURPHY, Chicago, Ill.; S. S. THORNE, Toledo, O.; W. D. MIDDLETON, Davenport, Ia.; A. J. BARR, McKees Rocks, Pa.

No. 8.


By E. R. LEWIS, A. M., M. D., KANSAS CITY, Mo.

One year ago, at our annual meeting in Chicago, I had the pleasure of presenting a paper on the subject, "Ununited Fractures; Development and Repair of Bone." Since that time I have seen three cases of ununited fractures, that is, ununited in the ordinary acceptation of the term, as laid down by our best authorities on the subject-who say that after six months, a broken bone which has not been repaired by bone will not be capable of so doing-and is an ununited fracture and will continue so without surgical interference, and this is the point I wish to correct, and verify by my own experience in three cases seen since our last meeting. One of the three cases occurred in my own practice, and was under treatment at our last annual meeting, but not sufficiently advanced at that time to be discussed in the paper presented then. My patient was a male, 41 years of age, foreman of a crew at our live stock yards. While loading a New York stock train, one of the animals became unruly, and in attempting to force the animal into the car, it fell between the car and the platform, catching the patient's right leg between the edge of the heavy oak platform and the animal's body and not only fracturing the bones, but comminuting them, cutting the vessels and thereby producing an enormous subcutaneous hemorrhage. When I arrived at the yards and examined the patient, who was stretched out on the floor of the pen. I did not think it possible to get him home without the sharp fragments of bone making our injury a compound comminuted fracture,

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

but the police patrol wagon attaches proved quite skillful in the handling of the patient and he was laid upon his bed a mile away with the cutaneous tissue still intact, though exceedingly thin at more than one point, and enormously strutted with the homorrhage, which seemed to be still going on.

The idea of evacuating the blood was debated, but I feared to convert my injury into a compound one, so applied temporary splints for the first week, after which time I used a plaster cast, leaving it on for six weeks. At the end of that time I found no union. I again applied the plaster, after using some friction of the ends of the bones, leaving it on more than three months from the time of the original injury, and at the expiration of this long time found no union. After the removal of the first cast and the application of the second, my patient was up and around on crutches all of the time. I removed the second cast in the fourth month, and although the patient was around all the time, I used only light splints about the point of the non-union during the day, removing them at night, and finally leaving them off altogether as the limb got stronger and stronger under the daily use of massage. In fact, after the removal of the permanent splints, I had the patient submit himself to an expert masseuer almost daily for several months, before bony union occurred, which was about the last of the seventh, or the first of the eighth month; and now, after fourteen months from the date of injury, he is attending to his work in the live stock yards as before. Having a great desire to see what condition the bones were in, I availed myself of the great courtesy of Professor Lucien I. Blake of the University of Kansas to submit my patient to the Roentgen rays for the purpose of making a skiagraph of the leg. After the plate had been developed, I was delighted to be able to see continuous bony repair in both tibia and fibula.

The second case I saw for the last time during the year, proving that bone will repair itself with bone after six months, occurred in the practice of a member of the National Association of Railway Surgeons, the chief surgeon of the Kansas City, Ft. Scott & Memphis Railroad. The patient was injured in Arkansas in 1889 and was treated in the company's hospital in Kansas City during the year

ending July, 1890. I saw this man with Dr. N. J. Pettijohn, the chief surgeon of the road, during the time he was in our town, and from the very extensive injury, did not at one time think the limb could be saved, even with a false joint, but as to the fallibility of my judgment, I leave you to judge after reading the history of the case, as kindly furnished me from the hospital records by order of the chief surgeon. The record showed the following, viz.:

"Charles W. Barton, fireman, aged 35. was injured September 24, 1889, by an engine leaving track and his right leg being caught in the debris, crushing the tibia and fibula at the junction of the middle and upper thirds, producing a compound comminuted fracture of the tibia, with a section of two inches of the fibula entirely removed. All of the anterior skin, muscles and vessels were crushed and extensively lacerated over the seat of injury. On the day after the injury the patient was brought to the General hospital at Kansas City, all of the loose fragments of bone removed, the ends of the tibia and fibula approximated and wired and the lacerated muscles adjusted with buried sutures, the limb dressed and placed in a side splint for six weeks, after which it was put in a permanent plaster of Paris splint, so arranged that the necessary dressings could be applied without interfering with the process of repair. (The wire sloughed out.)"

This patient remained in the hospital about ten months, being discharged July 17, 1890, without solid bony union, there being slight motion at the seat of injury. He was furnished with a shoe and lateral braces, which gave support to the limb, with instructions to use it as much as possible on crutches. Three months after leaving the hospital there was a solid bony union, and the limb is now as strong as the other, with the exception of two inches shortening. Thus it will be seen that after eleven or twelve months, this patient was rewarded by most complete bony union.

Our third case occurred in the practice of our fellow member, Dr. A. O. Williams of Ottumwa, Ia., and I here embody his report of the case, in the following letter, dated April 18, 1896, viz.:

Ottumwa, Ia., April 18, 1896. Dr. E. R. Lewis, Kansas City, Mo. Dear Doctor:-I consider that I owe you

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