« ForrigeFortsæt »
the preservation of tissue, the conservation of function, the limitation of sepsis-"surgical fever" and the saving of human life.
THE PHYSICIAN AND THE PUBLIC PRESS.
The following items are clipped from the editorial column of the Columbus (Ohio) Dispatch. We refrain from comment, as we have no further knowledge of the row, but the editorials well illustrate the feeling of the lay press and a large part of the people, relative to medical advertising, professional interviews and reports of operations in the daily prints:
"In finding Dr. R. Harvey Reed guilty of a violation of the code of medical ethics in connection with the publication of a report of a most successful surgical operation in a daily paper, the Academy of Medicine has not exhibited either that fairness or liberal spirit or that sympathy with the spirit of modern progress that might naturally be expected from a body of intelligent men who belong to one of the greatest of professions. This drawing of the line between professional and daily papers is an evidence of professional prejudice that is not at all creditable to the physicians who have given countenance to it.. But they might as well expect to dam the mighty Nile as to check in this way the progress of the newspaper or hide under the bushel of professional exclusiveness the light of individual success."
"THE MEDICAL PROFESSION.
"The case of Dr. R. Harvey Reed calls attention to the fact that the medical profession is the only one of the once only great professions-law, medicine and theology-that still keeps up many of the old barriers of exclusiveness. There was a time when all of them wrapped themselves up in more or less mystery and were inclined to bid the uninitiated stand aloof. They were as a rule very sensitive to anything that smacked of intrusive familiarity on the part of the general public.
"But most of these barriers have gradually given away under the leveling processes of modern inquiry and development. The professions no longer monopolize learning as they formerly did. The masses of the people know a great deal more than they used to know, and they also know the difference between. actual knowledge and the mere profession of knowledge. The dignity of professions is no longer the dignity of tradition but the dignity of knowledge. They simply share this dignity with all other occupations. Every business is dignified that is honorable and that represents intelligence and character. All
this has tended to improve and strengthen the professions, for it has had the effect of weeding out of them the shams and pretentions, that at one time infested them and were safe from assault because they were protected by the artificial sanctity that enveloped them.
"The medical profession has been more inclined to resent this modern intrusion than the others. It has hugged its secret rites more tenaciously. It has clung more closely to its Latin formulæ. It has been more sensitive to the inquiries of the newspapers as the representatives of the people, into its doings and methods, and has been disposed to resent it as impertinent familiarity. It has been behind no profession or occupation in its advancement in learning. Its members can hold their own in point of intelligence and capacity and character with the members of any other profession. And as to the good its members are doing, not only in relieving suffering and saving life, but in in adding their their contribution to the world's progress, too much praise cannot be given to them.
"At the same time we believe the profession makes a mistake in opposing newspaper publicity to the extent that it does. The masses of the people do not have access to medical publications. They depend almost entirely on the daily papers for information on current events. They are interested in surgical operations and their interest is a natural and eminently proper one. If the publication of the details of an operation incidentally gives credit to the one who performs it, that does not render it any the less interesting or instructive, though it may strike a sore spot in the breasts of some physicians who chance to belong to a different school of practice or to be interested in a different school of instruction.
"It will not hurt the profession any to take the people into its confidence and let them know more of its doings and its methods. Indeed it will do it good. People know more now than some doctors seem to think they do. This very intelligence, if the doctors could but see it, enables them to better understand and appreciate the physician's learning and skill. Moreover, the people will continue to get sick and need the services of doctors, so that there is no danger that the profession will run any risk of losing its occupation."
It is said that the tendons found in the tail of a dog make better sutures than either catgut or kangaroo tendon, when properly prepared in sublimate.-Peoria Medical Journal.
We have not only multiplied diseases, but we have made them more fatal.-Rush.
Notes of Societies.
The Pan-American Medical Congress.
As already announced in The Railway Surgeon, the Pan-American Medical Congress will convene in the City of Mexico, November 13-16, 1896. A cordial invitation is extended by the International Executive Committee to the medical profession of the United States to attend and participate in the meeting. The titles of papers to be read should be sent at as early a date as possible to the secretary, Dr. Eduardo Liceaga, Calle de San Andres, num. 4, Ciudad de Mexico, D. F. Republica Mexicana, and all those who contemplate attending should send their names and addresses as early as possible to Dr. C. A. L. Reed, St. Leger place, Cincinnati, O. Dr. Reed writes: "Dr. H L. E. Johnson, 1400 L street N. W., Washington, D. C., has been elected chairman of the Special Committee on Transportation. All communications relative to rates, reservation in the special trains, etc., should be addressed to him.
"A rate of one fare for the round trip has been secured between St. Louis, New Orleans and other trans-Mississippi points and the City of Mexico. It is confidently expected that this rate will be extended over the entire territory of the United States. Arrangements are in progress for a splendidly equipped special train of sleeping and observation cars, with first-class dining-car service. Dr. Johnson will presently be in a position to announce a rate, which will include railroad fare, sleeping and dining-car service both ways and in the city of Mexico, and covering the expense of various side trips to the most historic points in the Republic."
President Lutz has appointed the following members of the National Association of Railway Surgeons as delegates to the Pan-American Medical Congress:
Dr. Henry F. Hoyt, Chief Surgeon Great Northern R. R., St. Paul, Minn.; Dr. C. W. P. Brock, Chief Surgeon C. & O. R R., Richmond, Va.; Dr. W. D. Middleton, Chief Surgeon C. R. I. & P. R. R., Davenport, Ia.; Dr. G. W. Hogeboom, Chief Surgeon A. T. & S. F. R. R., Topeka, Kas.; Dr. E. F. Yancey, Chief Surgeon M. K. & T. R. R., Sedalia, Mo.; Dr. J. B. Murphy, Chief Surgeon Wisconsin Central R. R., 911 Venetian Building, Chicago, Ill.; Dr. Truman W. Miller, Chief Surgeon Grand Trunk R. R., 612 Reliance Building, Chicago, Ill.; Dr. A. C. Scott, Chief Surgeon G. C. & S. F. R. R., Temple, Texas; Dr. F. A. Stillings, Chief Surgeon Southern Division B. & M. R. R., Concord, N. H.; Dr. J. W. Tope, Surgeon C. & N.-W. R. R., 30 Pleasant street, Oak Park, Ill.; Dr. James Thorburn, Consult
ing Surgeon Grand Trunk R. R., Toronto, Canada; Dr. J. H. Williams, Chief Surgeon M. D. & S. R. R., Macon, Ga.: Dr. J. N. Warren, Chief Surgeon S. C. & N. R. R., Sioux City, Ia.; Dr. W. R. Tipton, Consulting Surgeon A. T. & S. F. R. R., Las Vegas, N. M.; Dr. D. F. Stuart, Chief Surgeon H. & T. C. R. R, Houston, Tex.; Dr. G. P. Conn, Chief Surgeon C. & M. R. R., Concord, N. H.; Dr. H. W. Morehouse, Chief Surgeon Wabash, Danville, Ill.; Dr. W. B. Outten, Chief Surgeon Missouri Pacific Ry. Co., St. Louis, Mo.; Dr. W. A. McCandless, Chief Surgeon Terminal Railway Association, St. Louis, Mo.; Dr. E. R. Lewis, Kansas City, Mo.; Dr. C. D. Wescott, oculist for the C. M. & St. P. R. R.. Chicago, Ill.; Dr. C. A. Wheaton, Chief Surgeon St. P. & D. R. R., St. Paul, Minn.; Dr. Warren W. Weaver, Surgeon B. & O. R. R., 6105 Woodland avenue, Philadelphia, Pa.; Dr. E. N. Allen, Chief Surgeon C. & O. R. R., South McAllister, I. T.; Dr. A. I. Bouffleur, Surgeon C. M. & St. P. R. R., 738 Washington boulevard, Chicago, Ill.; Dr. W. R. Hamilton, Vice-President N. A. R. S., Pittsburg, Pa.
Annual Convention of the Medical and Surgical Staff of the Erie Railway Company.
The annual meeting of the Association of Erie Railway Surgeons was held at the Kent House, Lakewood, N. Y., Sept. 21, 1896. An accident occurred at the opening of the session which interfered with the pleasure of the entire gathering. Dr. John L. Eddy of Oiean, the president of the association, an aged and well-known surgeon, stepped into an open elevator shaft and fell to the bottom, a distance of eight feet. He was at once removed to his room at the Kent House, where it was found that he had sustained a deep cut across the forehead, a badly sprained ankle and a severely bruised hip.
On account of this accident to the president, the vice-president, Dr. Webb J. Kelly of Galion, O., presided. Dr. S. Birdsall of Susquehanna, Pa., presented a paper on "Symes Ankle-joint Amputations," and the discussion which followed was joined in by Drs. C. S. Parkhill of Hornellsville, George H. Hall of Binghamton, J. A. Ritchey of Oil City and T. B. Lashells of Meadville.
Dr. F. W. Thomas of Marion, O., gave an address on "Injuries of the Throat." Dr. C. C. Kinnaman of Ashland, O., presented a paper on "Symmetrical Gangrene," and Dr. C. M. Daniels of Buffalo, chief surgeon of the Erie Railway, told about his relief and hospital organization scheme, as intended to be adopted by the company.
The afternoon programme consisted of papers on "Traumatic Spinal Neurosis," by Dr. N. R.
Harnden of Waverly, N. Y.; "Painful Stumps Notes, News and Personals.
After Amputation," by Dr. C. B. Kibler of Corry, Pa.; "Railway Shock," by Floyd S. Crego of Buffalo; "Clinical Review of Cases the Past Year," by Dr. Thomas Manley of New York.
The session was attended by a larger number of surgeons than any former meeting in the history of the association.
The annual election of officers resulted as follows: President, Dr. Webb J. Kelly, Galion, O.; vice-president, Dr. F. W. Thomas, Marion, O.; secretary and treasurer, Dr. W. W. Appley, Cohocton; executive committee, Dr. C. M. Daniels, Buffalo; Dr. C. S. Parkhill, Hornellsville; Dr. L. H. Leyman, Huntington, Ind. The executive committee will select the next place of meeting, probably in New York.
(415) Surgery of the Spine.
Parona (Il Policlinico, May 15, 1896), reports four cases of spinal affection. The first was one of long-continued dorsal neuralgia affecting the seventh and eighth dorsal nerves on the left side. None of the usual remedies did any good, but injections of KI deep into the situation of the nerve roots cured permanently after eight injections. Fifteen grains were given on alternate days, and improvement was noticed after the third injection. There was some reason to suppose that the case was rheumatic. The second case was one
of persistent, troublesome neuralgia affecting the seventh and eighth pair of dorsal nerves, and probably due to a fractured spinal process (eighth dorsal) twenty years before. The injured spine was exposed; no bony pressure was found. The author therefore thoroughly stretched the nerves near their exit from the vertebra foramen, and so freed them from the old thickening. The result was permanent and speedy cure of the neuralgia. The two other cases were each tuberculous in nature, and consisted of caries of the transverse process and body of the third and fourth dorsal vertebra, accompanied by mediastinal abscess. The abscess cavity was freely exposed and drained from behind, and the patients recovered locally, but one died a few months after from pulmonary phthisis (of which there was no sign at the time of operation), and the other showed signs of phthisis. Both patients were adults, and there was no deformity of the spine. Mediastinal abscess was suspected, from the fact that when the external abscess was completely aspirated it almost immediatly filled again, the quantity of fluid extracted being out of proportion to the volume of the visible swelling, and the abundance and flow of the discharge through the fistula being manifestly affected by the coughing of the patient.-British Medical Journal.
The death is reported of Dr. W. G. Kingsbury of Boerne, Texas. The doctor was widely known in his own state as a good physician and public-spirited citizen. He was formerly connected with the Southern Pacific Railway and organized in England a colony which settled in a place named for him on the line of that road.
We regret to record that Dr. John L. Eddy of Olean, N. Y., ex-president of the Association of Erie Railway Surgeons, and one of the vice-presidents of the National Association of Railway Surgeons, recently sustained severe and painful, but fortunately not serious, injuries, by falling a distance of eight feet into an open elevator shaft. We feel sure that the doctor has the sympathy of all his many friends among the railway surgeons.
Dr. James Edgar Chancellor died Sept. 11, 1896, at his residence, University place, University of Virginia, at the age of seventy-one.
Dr. Chancellor was the son of the late George Chancellor, was born at Chancellorsville, and was a brother of the late Lorman Chancellor of Baltimore, and cousin of Dr. Chancellor, consul at Havre, France. was educated at the University of Virginia and at Jefferson Medical College, Philadelphia, for his profession, the practice of which he began at Chancellorsville. The war coming on, he was commissioned first assistant surgeon and then surgeon in the Confederate army, and assigned to duty at the general hospital at Charlottesville. He was made demonstrator of anatomy in the University of Virginia, where he remained until his health imperatively demanded his retirement. became president of the Medical Society of Virginia, and during his term the state board of medical examiners of Virginia was organized, of which he became a member in 1890, and in which office he continued till his death. For twenty years he has been a member of the American Medical Association and of the American Public Health Association.
The first wife was Miss Josephine Anderson of Spottsylvania county, who bore him six children-Dr. E. A. Chancellor of St. Louis; Alexander Clarendon Chancellor of Columbus, Ga.; Thomas Sebastian Chancellor of New Orleans; Samuel G. Chancellor of the University of Virginia, and Josephine Chancellor, now deceased. His second wife, Mrs. Gabriella Mays Chancellor, survives him.
John Eric Erichsen, F. R. S., LL.D., Hon. M. Ch. and Hon. F. R. C. S., died at Folkestone, Eng., Sept. 23, 1896, from apoplexy.
He was born July 19, 1818, and educated
Some Recent Cases of Minor Surgery.*
at the Mansion House, Hammersmith, and Extracts and Abstracts. at University College, London. He was a Fellow and ex-president of the Royal College of Surgeons, a Fellow of the Royal Society, of the Royal Academy of Medicine of Belgium, the Imperial Society of Physicans of Vienna, the Academia di Guereti (Rome), the University of New York, and the American Surgical Association, and a member of various other learned and scientific institutions, home and foreign.
At the time of his death Mr. Erichsen was Emeritus Professor of Surgery and consulting surgeon to University Hospital, and to many other medical charities. He had been president of the Royal College of Surgeons of England, of the Royal Medical and Chirurgical Society, and of the Surgical Section of the Great International Medical Congress of 1881. He was appointed secretary to the Physiological Section of the British Association for the Advancement of Science in 1844; was member of the Royal Commission on Vivisection in 1875 was surgeon-extraordinary to the queen, and had been president of University College, London, since 1887.
Mr. Erichsen was the author of many works and essays on physiology and surgery. In compliance with an influential requisition, he contested, but unsuccessfully, the representation of the universities of Edinburgh and St. Andrew's at the general election of 1885.
It is with peculiar sadness that we announce the death of Mrs. Fannie Peckham Thorne, wife of our distinguished ex-president, Dr. S. S. Thorne of Toledo, O.
She died at her residence, 502 Lagrange street, Sunday morning, October 11, at 1:30 o'clock. Mrs. Thorne had been ill for some time and her death was not altogether unexpected. She complained of a sudden sickness during the afternoon and grew rapidly worse as the night wore on, and when the end finally came she passed away in the midst of her family. She was in her 61st year and had been a resident of Toledo for 36 years. She was married to Dr. Thorne at Lockport, N. Y., in 1856 and four years after removed to Toledo, where her husband entered upon the practice of medicine.
She was born in Utica, N. Y., in 1835, and was the daughter of Dr. Peleg B. Peckham. She was the mother of the late Dr. George Thorne, and three other children, Annie, Laura and Alice, all living.
Mrs. Thorne was well known to many members of the National Association of Railway Surgeons, who will join us in extending to Dr. Thorne and his family sincerest sympathy.
Take physic, pomp; expose thyself to feel what wretches feel.-Shakespeare.
BY F. B. TIBBALS, M. D., DETROIT, MICH.
I am well aware that the only popular surgery of the present decade is gynecological, but as this specialty will not accommodate all of us, the adult female comprising only about twenty-five per cent of the total population, there must of necessity be general practitioners and general surgeons.
The general practitioner of surgical bent, however, occasionally finds surgical cases in which lesions exist outside of the pelvis and abdomen, some of them trivial in character as regards hazard of life, yet all demanding treatment along good surgical lines. I wish to report to-night some cases of this kind-minor surgery-which have come under my care, mostly within the last two years.
Some of these cases seem possibly too trivial to report, but success in little things often pleases the patient, and occasionally lives are at stake as well. For convenience in discussion I will classify my cases under three heads and for brevity's sake avoid all unnecessary detail.
I. ABSCESSES AND POISONED WOUNDS. Retropharyngeal abscess resulting fatally. -The patient was a woman of uncertain antecedents. When first seen she exhibited a temperature of 105 degrees Fahrenheit, and was suffering from dysphagia, vomiting and purging. Examination of the throat disclosed no abnormal condition except diffuse redness of the pharynx. The tongue soon swelled so that further examination was impossible, and the patient died suddenly two days later, suffocated by the bursting of the large abscess disclosed postmortem.
Retrorectal abscess, absolutely painless, rupturing without any premonitory symptoms into the rectum four inches above the anus. I could pass a probe some six inches into the fistulous tract leading off from the rectum posteriorly, and was thus able to wash out the abscess cavity with hydrogen peroxide. and other antiseptics, throwing in afterward, through a powder blower, boric acid plus a little iodoform. The cavity closed down after three months' treatment, but the fistulous track, kept open by the involuntary muscular action, continues at times to discharge a little pus aggravated always by constipation. As this patient has since been assured by several Detroit physicians of supposed intelligence that he never had such an abscess, but, on the
*Read before the Detroit Medical and Library Association and published in a recent issue of the Physician and Surgeon.
contrary, catarrh of the stomach with intestinal sequellæ, I take this opportunity of reporting the case at this length.
Superficial abscesses in the cervical and axillary regions are generally due to breaking down of lymphatic glandular tissue and usually heal promptly after free early incision, curettage and packing for drainage. I have a record of a dozen such cases which I will not weary you in detailing. Oftentimes suppuration beginning in this way, if not promptly treated, is carried by metastasis to other glands adjacent or remote, and the case may terminate in general pyemia or general tuberculosis. A striking illustration of this fact has been for nearly a year under my care, the patient being a girl of about twenty without hereditary taint. The trouble began some three years ago in one or two superficial glands of the neck, which were not incised. In a few months all the glands of one side of the neck, both superficial and deep, became infected, and a radical operation then undertaken failed to extirpate more than a part of the diseased tissue. When she came under my care last summer one side of the neck and part of the face was a mass of suppurating fistulous tracts, and there were also four open unhealthy sores elsewhere as sequellæ of abscesses allowed to rupture spontaneously. Within a short time I opened and drained ten other abscesses, all but one subcutaneous. Every effort was made by tonic supportive treatment internally, and stimulating antiseptics locally, to build up the patient and antagonize the autoinfection with, for some months, gratifying success. No new abscesses formed, many of the open sores healed kindly and the patient gained in weight and strength. But on the opening of winter suppuration began anew, attended by emaciation, loss of strength, afternoon temperature and night sweats, and the case is now persistently retrograding. In all probability this poor girl's life might have been saved by timely surgical treatment at the inception.
The same reasoning applies to suppurating nonvenereal glands of the groin. I have four cases recorded-two of which were incised, curetted and packed as soon as pus began to form, and two of which came into my hands at a later stage. The first two healed promptly, while the others dragged a weary course of several months.
Abscesses of this character occurring usually in individuals of the strumous type are frequently obscurely tubercular, and the prompt removal of the local nidus will often prevent secondary systemic infection. Another argument for early surgical interference in all cases in which pus can be diagnosed or even suspected is the prevention of deformity and loss of function. A housemaid came to me a year ago, presenting a useless hand as a result of a neglected felon on one of the fingers. The
wrist was absolutely stiff, the fingers nearly so. I broke up the adhesions by considerable force under anæsthesia with daily passive motion following, repeating this forcible manipulation under anæsthesia every ten days for three months, at which time I had obtained only slight wrist movement, but perfect use of the fingers.
From quite a number of poisoned wounds I select three of the hand in which the cut was made by glass. All were seen immediately after the injury, carefully cleaned, fragments of glass searched for, and antiseptic dressing applied. I do not know whether the irritant. is traumatic, chemical or bacteriological, but in my experience wounds of this kind are very slow in healing. Even when there is no pus formation the edges become inflamed and infiltrated, union by first intention being the exception.
II. INJURIES TO JOINTS.
Compound dislocation of the Elbow.-This patient was a locomotive fireman, injured fifty miles outside the city. While oiling his engine the throttle flew open and his arm was caught in the driving wheel, a compound dislocation of radius and ulna backward resulting. The dislocation was reduced, wound dressed, arm put in a rectangular splint, and the patient sent to his home in Detroit. I did not disturb the dressings until thirty-six hours after injury, when he had a short chill, the temperature rapidly jumping to 103 degrees. Fahrenheit. I found the arm doughy, swollen and inflamed to the shoulder and the elbow
joint full of pus. Free incisions were made and drainage tubes introduced in several directions through and about the joint and free irrigation used two or three times daily of hydrogen peroxide, full strength. In forty-eight hours he was out of danger. Passive motion was begun early and to-day the arm is as good
Two cases of separation of the lower epiphysis of the humerus treated by angular anterior and posterior splints and early passive motion. The diagnosis between this condition and fracture above the condyles is sometimes difficult, but in children epiphyseal separation is the more common.
I had the pleasure recently of examining a fractured elbow-joint, the result of great indirect violence in a girl of sixteen. There had been a fracture across both condyles, the fragment being split vertically with dislocation of both radius and ulna. The surgeon attending had found it impossible to maintain everything in normal position, and the result after two and one-half months was ankylosis in the true joint, with a good false joint through nonunion of the fracture. I advised, and I think rightly, noninterference, as the arm is free from pain, and can be perfectly flexed and ex