lowed to remain and to become embedded in the granulations of the wound, which healed by suppuration. Neither the stitch nor the plate at any time caused the slightest disturbance in the tissue or inconvenience to the patient. Much has already been observed in the use of silver wire that is worth recording, and enough to satisfy us that it will play a new and more important role in the surgery of the near future.-Boston Medical and Surgical Journal.

Rupture of the Liver.

At a recent meeting of the College of Physicians of Philadelphia, Dr. William J. Taylor presented a specimen which was obtained from a boy sixteen years of age. He was standing holding a horse which was attached to a wagon backed up to the sidewalk at right angles to a trolley track. A car struck the wagon, knocked it over upon the boy, and pinned him to the ground.

When taken to St. Agnes' Hospital there was very great shock, but no external evidence of injury. He had a great deal of difficulty in respiration, which was very rapid, and a very quick pulse. He lived for twenty-two hours after the accident.

When Dr. Taylor saw the boy the night of his admission to the hospital he was in such a profound shock that nothing could be done in a surgical way, and there was evidently some serious internal injury. Other than this no diagnosis was made.

The post mortem showed a very extensive rupture of the anterior surface of the liver. When the chest was opened the right pleural cavity was found filled with clotted blood, and the root of the lower lobe of the right lung was torn through. The other organs were normal; the peritoneal cavity was filled with blood, and the stomach and intestines were enormously distended.

Dr. White said that one would suppose that such a rupture would be followed by immediately fatal hemorrhage. It is hardly to be thought that any surgeon would venture in a healthy liver to make an operative wound of the size and depth of the rupture in the specimen presented and hope to restrain fatal bleeding.

Dr. W. J. Taylor referred to one case in which the liver was intentionally wounded by. Dr. Keen when he removed a tumor a few years ago, but Dr. White recalled the fact that in that instance the division of tissue was done by the galvano-cautery.-Annals of Surgery.

God is the restorer of health and the physician puts the fee in his pocket.—Italian.

Miscellany.

The Country Doctor.

The country doctor! Let the bard
Whose lyre is tuned to idle praise-
His locks unshorn, his face unmarred
By sweat and grime, his hands unscarred
By daily toil-in dulcet lays,
In empty word and hollow phrase
Recount the annals of the great;
Let him record and celebrate
Their noble deeds; their pomp and state;
Their wisdom-all, perpetuate.
A humbler theme to you I bring-
The smell of flow'rs, the breath of spring,
The flutter of the bluebird's wing-
And with it all I bring to you
The country doctor, good and true.

The country doctor! Him whose life,
From sun to sun, is daily rife
With bootless toil and ceaseless strife;
Whose sturdy frame is made to feel
The summer's flame, the winter's steel-
I come to sing in praise of him.
His soul is fat; his purse is slim;
His eyesight keen; his foresight dim-
For caring naught for power or pelf,
While there's a crust upon the shelf,
He works for fun and boards himself!

Ah! ye, who traverse city streets,
On swaying springs and cushioned seats,
The difficulties that he meets-
The bumps and jolts—ye little know,
Through seas of mud, o'er wastes of snow,
Where icy tempests howl and blow,
In pouring rain, where torrents flow
And sheen and shadow come and go,
Astride the sorriest of nags

And armed with spur and saddlebags,
He onward works his weary way;
And be it night or be it day,
He never falters nor looks back
Adown the steep and rugged track,
But sets his teeth and onward plods-
Himself a clod among the clods!

I've said "A clod among the clods."
'Twere better-"God among the Gods!"
For sacrificing hours of ease
And striving hard to do and please
And winning but the dregs and lees
Of life's sweet wine, he fights disease
With clenched hands and bated breath—
And knows no conqueror but death.
It shames me not to tell the truth-
An unkempt, muddy god, forsooth!
Besmeared, bespattered, leggings, suit--
From crown of hat to sole of boot,

And ofttimes tumbled in the wave
That seems to yawn a watery grave,
He bobs serenely on the flood
And swims about the sea of mud.
For lo! his pockets are so light
He cannot disappear from sight!

No scientific friend has he
Who ends his name "A. M., M. D."
Or tacks thereto a “Ph. G.”—

To help him in perplexity,
And earn them both a handsome fee;
But when he finds a knotty case,
A problem that he dare not face,
He sends his patient off to town
To some physician of renown.
(God save the mark! All, all are great
Who dwell within the city's gate!)
And this great man dilates his eyes
And rubs his hands, looks wondrous wise-
And nimbly gobbles up the prize!
The city doctor counts his gold,
Makes fresh deposits in the banks,
And sends the country doctor, old-
A neatly worded note of thanks!

To church the city doctor goes,
(Ye need not smile and wink at me
And strive his spotless name to smirch;
I'm told on good authority
The city doctor goes to church)
To take an hour's profound repose,
To hear the gilded organ ring,
To say his prayers and nod and doze
And see the sweet soprano sing;
The organ peals; the tenor squeals—
Great Scott! how good that doctor feels.
The selfsame hour, the selfsame date,
The country doctor-sport of fate-
Moves up some gully's rocky course,
Astride his rhubarb-colored horse.
The only anthem that he hears,
The only tune that greets his ears
Is murmured by the evening breeze-
Which moans "Old Hundred" thro' the trees!

And countless ills-and does it, too,
Without a thought or hope of gain;
Without a single cent in view!
I come to sing in praise of him
Whose soul is fat; whose purse is slim;
Whose eyesight keen, whose foresight dim,
For caring naught for fame or pelf,
While there's a crust upon the shelf-
He works for fun and boards himself.
-From the Ohio State Journal.

Iowa State Association of Railway Surgeons.

We are requested to announce that owing to the meeting of the Masonic Grand Chapter, the date of meeting of the Iowa State Association of Railway Surgeons has been changed to October 7 and 8, 1896.

A sporting character, fond of his mare, used to call the animal "his dear Flora." One day his dear Flora threw him and a wag observed of the accident, "that it was a shocking thingMr. S.'s Flora had miscarried."

Physicians, of all men, are most happy. Whatsoever good success they have, the world proclaimeth, and what faults they commit the earth covereth.-Quarles.

An ill wrestler turned physician. "Courage," says Diogenes to him, "thou hast done well, for now thou wilt throw those who have formerly thrown thee."-Montaigne.

FOR SALE.

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

VOL. III.

CONTENTS OF THIS NUMBER.

ORIGINAL ARTICLES:

The Railway Employes' Hospital Association-by DR. GEO. CHAFFEE...

PAGE.

193

.....

Changes in the Spinal Cord Following Amputation....

207

209

213

214

214

Management of Cases Immediately Following Operations....

215

The Management of Railway Hospitals.. 215 A Neat Spherical Gauze Sponge. NOTICES AND REVIEWS

216 216

Officers of the N. A. R. S., 1896-7.

President....
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.

Secretary.
Treasurer..
..E. R. LEWIS, Kansas City, Mo.
Executive Committee:-A. I. BOUFFLEUR, Chicago, Ill., Chair-

man:

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

No. 9.

THE RAILWAY EMPLOYES' HOSPITAL ASSOCIATION.*

BY DR. GEO. CHAFFEE, BROOKLYN.

Founder and Ex-President New York State Association Railway Surgeons.

The history of this beneficent association dates back to the year 1869, when the late Mr. A. N. Towne, vice-president of the Central Pacific Railway, organized and put it in operation on that line. The association early became popular with railway' men and its field of operation has been extended until the popular wave has reached the Atlantic coast via the Plant System and the C. & O. It has been thoroughly tested by conservative people, has become a fixed branch of the operating department and it is not at all likely that it will ever be abandoned. Prominent among the lines which have organized and are now operating the hospital association may be named the Great Northern, Northern Pacific, Union Pacific, Central Pacific, Southern Pacific, Denver & Rio Grande, Texas Pacific, Santa Fe, Missouri Pacific, Wabash, Big Four, Plant System and the C. & O. Steps are now being taken to organize this hospital association on the Erie Railway.

I am under obligations to Dr. W. H. Morehouse, chief surgeon of the Wabash Railway, for the accompanying photo of the Wabash hospital at Moberly, Mo., and for a brief description of the same, as follows:

"I send you by to-day's mail a photograph of our Moberly, Mo., hospital, with accommodations for about sixty patients. The diningroom, kitchen and nurses' sleeping rooms are in a building detached from the hospital building proper, but connected by a lighted and heated corridor. We thus have no kitchen odors in the hospital building. This photograph was taken immediately after comple

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

tion of the building, when the ground was in a rough state. Since then we have a beautiful, smooth, well grassed lawn, and during last spring and summer it was the most beautiful I had ever seen.

"We are beginning the construction of a hospital at Peru, Ind., to replace the old one at that place which we are now using. This will be a singularly beautiful building; the basement is to be of cut stone; above that of pressed brick, a buff color; the roof to be of green tile. This building is to be situated on a piece of ground containing over two acres. I should have added that in the Moberly grounds there are three and a half acres."

DR. GEO. CHAFFEE, SURGEON TO LONG ISLAND RAILROAD.

There is a point from which the hospital system may and should be viewed, which is high and most worthy, and that is from the humanitarian standpoint. Looked at from this point, railway men should, without the aid of a glass, be able to see that with this system the welfare of the employe is being properly looked after. When an employe falls sick or is injured-where this system is in operation-he is promptly, and with care, removed to the company's hospital, an institution in which he is himself a stockholder and part owner, and in which, by his monthly assessments, his bills are paid in advance, an item

of no small account. Employes are not all able to be treated in luxurious homes, but their cuts, fractures and injuries are just as sore and painful as though they were able to afford the best of everything. The simple adoption of this system on the part of the company, and the consent of the employe to the light monthly assessment, will place him in a position to receive and enjoy the very best treatment in the land, and when cured he will be discharged from the hospital and returned to his position at the earliest possible momentfree from debt.

The employes of our lines are on the train, constantly facing danger, and must meet the crash when it comes. Wrecks have occurred and will continue to occur "just so long as human agents are necessary in the manipulation of railways." And since this is true, we should neglect no particular whereby their horrors may be palliated. Is it not far better to be fully prepared for half a dozen wrecks along the line, than to have even one occur with no preparation whatever? The answer is short and easy, but we leave it unwritten. General practitioners, who are suddenly called to the scene of an accident, are often obliged to go poorly prepared for the work, and if to this we add lack of system, they are terribly handicapped in their efforts to relieve.

If we have adopted up-to-date and approved methods, and done our very best in applying the same, then we have done our duty, our conscience is clear, our minds at rest, and there will be little room for public criticism. The hospital association fund provides (1) an emergency box of simple dressings and soothing remedies on every train; (2) local and specially trained surgeons all along the line; (3) a chief surgeon to direct the efforts of local surgeons and for consultation; (4) a railway hospital or home, at convenient points, where sick and injured employes are cared for; (5) a relief car at division towns, with beds, stretchers, warm blankets, restoratives, anodynes, splints, surgical-dressings and instruments for all emergency work.

With the association of the A. T. & S. F., the monthly assessments for the hospital fund are as follows:

"From employes' earning during the month: $30 or less ..25 cents per month $30 and less than $60...35 cents per month

"The employes assert that they save money by paying the assessment which constitutes a hospital fund, as prior to its establishment, sick and injured employes were helped out by other employes and friends contributing to subscription lists carried about by the generously inclined, and that it was not uncommon for men to give, under such circumstances, fifteen, twenty or more dollars a year, for such a purpose. The men say that, while some might doubt the right of assessments, still this point is not now considered, in view of the benefit conferred upon those who really needed it. The hospital system has stood the test of time for many years and must certainly possess merit, as the compulsory elements of the assessments would, naturally, produce prejudice unless some redeeming virtue was constantly manifest. The small assessment is not deemed a burden by the employes, and the hospital system is viewed as a benefit.

"We maintain that a properly conducted hospital department upon a railway is more conducive to loyalty than any other existing form of relief association. It at least offers opportunity for the manifestation of that good will and consideration which a widely diverse and extended interest seemingly prevents. In the precincts of a hospital the manifestation of kindness, consideration and humanity are not subversive of discipline, but are at all times a gracious aid in treatment. A railway hospital partakes more of the nature of a home than it does of the cold nature of a general hospital. Its every element is based upon a thoroughly unselfish desire in providing the best possible elements of subsistence, treatment and results.

"We do not believe that it can be demonstrated that any relief association connected with any prominent railway can obtain from any hospital, not owned or rented, the same beneficial results in all directions, as the one under its own government and control. The peculiar influences of a railway hospital upon its patients should be seen before they can be thoroughly realized. Railway men are naturally clannish and they take pride in direct contact and in discussing the diverse experiences of their vocation; and it is in the nature of a curative measure for railway men to have

their surroundings thoroughly railroadish, and as has been said before, the homelike element is the one which satisfies the railroad man."

In response to my request for a statement from employes in regard to their opinion of the hospital association, Dr. Frank H. Caldwell, chief surgeon Plant System, makes the following reply, which, with the letters from two railway men, speaks volumes in favor of the hospital association, and for which we tender our sincere thanks to the writers.

"Sanford, Fla., February 17, 1896. "Dr. George Chaffee.

"In compliance with your request of February 8 I herewith inclose communications from Conductor L. K. Morris and Section Master J. E. Stokes. The former has been very ill with an attack of inflammatory rheumatism and has been in the hospital, as he states, some time. He is now convalescent and will soon be out. Mr. Stokes had an at

tack of typhoid fever, which came very near proving fatal. These two men are naturally grateful, and gladly wrote the letters, copies of which I inclose.

"The majority of the employes appreciate the Hospital Department. I believe if it was put to a vote as to whether or not the system should be abolished, nine-tenths of the men would vote to continue it. Of course the track men and train crews derive more benefit from the service than any others. Therefore, I obtained statements from the head of the transportation service, and head of the roadway gangs, i. e., conductor and section master. "Trusting this will meet your wants, I remain, Yours truly, "Frank H. Caldwell, Chief Surgeon." "Sanford, Fla., February 14, 1896. "Dr. F. H. Caldwell, Chief Surgeon.

"Dear Sir:-I have been in Hospital No. 1 two months, suffering from rheumatism, and I will leave in three days almost well. Previous to this time, I have been employed by