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utes I was surprised to find that it would bear a weight of sixteen pounds before breaking. So far as I can ascertain, twelve minutes is the longest time that bacteriologists consider that anthrax spores can resist boiling water. Surely, then, fifteen minutes' boiling ought in every instance to render catgut sterile.
Fracture of Skull; Prolonged Unconsciousness, With Probable Laceration of Brain.
The following interesting case is reported by Dr. H. Morell of Slayton, Minn.:
On April 27, 1895, G. N., aged 13 years, a large, strong boy for his age, while riding was thrown from a horse, and it is supposed that the animal rolled on him. He was carried to my surgery about half an hour after the receipt of the injury, in an unconscious condition. The pupils were equal, there was hemorrhage from the nose, breathing was easy and pulse 130. The forehead was bruised and was swelling rapidly; nose and upper lip contused. He was sent to his home on a stretcher, where he was undressed and wrapped in warm blankets, his head shaved, and ice applied, with warmth to the feet. He lay in a semiunconscious condition all day, passing water involuntarily. He did not speak when spoken to, but if roused would seem to understand. He vomited four or five times.
April 28: Patient's condition practically unchanged. Examination of the head showed no depression. From the severe bruise on the forehead, he seemed to have fallen directly on the frontal bone on the left side. Another physician was called in, who agreed with me. that bleeding was indicated, and it was done to the extent of sixteen ounces, from the right arm. After this there was marked improvement; the pulse was softer, and he answered a couple of questions in monosyllables. The pupils were equal and reacted to light. At this stage another surgeon was called who approved of the treatment but gave a dubious prognosis.
April 29: Patient still unconscious. The bladder was emptied, as he had not passed urine for some time. The integument over the eyes was puffy and extravasation of blood beneath the conjunctiva well marked. At 2 p. m. he seemed more conscious and opened his eyes occasionally; pulse 74; respiration 20; temperature not taken. At 5 p. m. he was restless; injection into the bowel was given, which was followed by a movement. Cracked ice was given and relished.
April 30: Condition improved. He seemed to take more notice of his surroundings; took nourishment well, as beef-tea and iced milk; rested better than since the injury.
May 1: Took nourishment well, as beef tea and iced milk; rested well; seemed to un
derstand what was said to him, but would not answer questions. May 2 and 3: provement.
Condition the same; no im
On the 5th 2 grains of calomel were given; in the evening the bowels moved, after an injection. Patient seemed conscious; opened his eyes, but would not speak.
May 20: Up to this date the patient had gained physically every day, but mentally there was not much improvement. Sometimes when spoken to he would answer very slowly, then immediately cry.
His parents took him to St. Paul for two or three days, and when he returned the change in his mental condition was remarkable. He seemed as well as ever he was. Up to the present time, nearly a year, he has been perfectly healthy mentally and physically.
The above is an interesting case from a clinical point of view. In my mind there is no doubt that this patient suffered from a superficial laceration of some of the frontal lobes of the brain. Authorities maintain that in those cases where consciousness is delayed over twelve hours there is more or less bruising and laceration of the cerebral substance. It is plain that the laceration occurred exactly at a point underneath the point where the frontal bone was struck, i. e., the orbital plate of the frontal bone; at the same time, possibly, the ethmoid and sphenoid bones were fractured. The bleeding from the nose and ecchymosis of the lids seemed to confirm this. The aphasia also seems to show that the lesion was in that region, pointing to the inferior frontal convolution of the left side. Again: cerebral irritation usually follows blows on the forehead, temple or occiput, the symptoms of which were so well marked during this patient's illness, as great restlessness, eyelids firmly closed, irritability of mind shown by frowning when spoken to in a loud voice, and when convalescent crying at the least provocation. Medicine.
The Illinois Steel Company has constructed a very complete and elaborate hospital at their South Chicago works, that will accommodate about fifty patients. In its construction the most modern ideas have been embodied and it stands to-day as probably the most satisfactory building of the sort in this or any other country, its purpose being to meet the emergency cases that arise among the thousands of operatives in this enormous plant. It is under the immediate care of Dr. James Burry as chief surgeon for the company, and an able staff of assistants. It was opened October 5 and a very pleasant opportunity was afforded a number of medical gentlemen of Chicago to see the building. They were particularly struck with its novel heating and laundry apparatus.
Notices and Reviews.
"A Treatise on Appendicitis," by John B. Deaver, M. D., surgeon of the German Hospital, Philadelphia. 32 full-page plates and other illustrations. Philadelphia: P. Blakiston, Son & Co., 1896.
A new work on appendicitis at this time is received with open arms, so to speak, by the medical profession. There is no disease which is claiming more attention at the present time and which is fraught with more serious dangers, and, withal, is so erratic in its course, as the one presented in this book. Every practitioner has felt the want of a clear, concise, systematic treatise on this subject, and I suppose that each of us have formed a mental opinion of what such a book should contain. The author of this volume has treated over five hundred cases of appendicitis, upon which clinical experience he bases the opinions expressed in his book. Such a large experience, should, indeed, place a man of Dr. Deaver's close observation and faithful devotion to details in a position to teach all of us something, if not much, about this varied and dangerous condition.
While it is really a pleasure to read the book, and I think one derives considerable benefit from the perusing of the various pages and from the study of the numerous illustrations, we are impressed with the fact that the work is particularly free from argument and that the author simply states his position, leaving the reader to accept it without any reasoning on his part. In a book pretending to be a treatise on such an important subject, and one concerning which there are so many different views, it would appear to the student of the subject that an author should give us argument, and where justifiable, conclusions. A careful study of five hundred cases should have enabled the author to give us some very valuable data in support of the conclusions which he has stated.
Dr. Deaver is known as an advocate of early operative treatment of this condition, but unfortunately this book does not convince us that such a course is always the best one to pursue. We need a great deal of light on this subject, and the sooner our writers give us the detailed results of their observation, the earlier we will be in a position to arrive at
safe conclusions. A mere statement of conclusions at this time is not warranted by all of the facts thus far presented.
The great questions of when to operate and the relative advantages of early and late operations, the mortality of non-operative cases and the dangers of recurrence, are still open for discussion, and there are others upon which we not only need light, but also safe and definite conclusions. While it is true that this book will serve as an addition to our literature on the subject, it must not be considered as a complete treatise carrying with it the authority of the present knowledge of the subject, but rather the opinions of a single surgeon. Most operators will take serious exceptions with the author concerning the advisability of the invariable removal of the appendix in all cases of appendicular abscess, even in skilled hands. There can be no question but that the subsequent removal under aseptic conditions will enhance the patient's chance for recovery.
As a product of the printer's art this book is certainly to be admired. The colored illustrations are, however, too highly tinted and present an exaggerated appearance, which is detrimental rather than beneficial, and the index is entirely inadequate. While we are somewhat disappointed in the book, as a whole there are numerous features presented which will make it a valuable work to the student of this subject and worthy of a place in every physician's library.
A Manual of Anatomy, by Irving S. Hayes, Ph. B., M. D., Adjunct Professor and Demonstrator of Anatomy in the Medical Department of the New York University, With 134 half-tone illustrations and 42 diagrams. Philadelphia: W. B. Saunders, 1896. 12 mo. Price, $2.50
A new work on anatomy is always received with a great deal of interest, since it is generally supposed that we have all of the facts of descriptive anatomy, as presented in our old standard Gray, and that whatever merits a new book may claim must be in the nature of a new method of presenting the facts, or in new means of illustrating and fixing the same upon the student's mind. This manual is no competitor of Gray's Anatomy, nor, on the other hand, is it to be classed with the small quiz compends which are decidedly more numerous than useful.
The principal feature of this book is the taking up of the subjects from a topo
graphical standpoint and describing the various viscera and structures in the order in which they are exposed in a dissection. While the consideration of various structures of the body systematically is necessary for the freshman student, in order that he may gain a complete knowledge of the various systems of the body, the plan of presenting all the structures in a collected manner is by far the best one for the more advanced student and especially for practitioners of medicine and surgery. In this respect this manual partakes more of the nature of a dissector.
The plan of illustrations is entirely new, and while the numerous half-tones give one a splendid idea of the appearance in the cadaver, there is not as much contrast between the tissues as we find in the living subject. On the whole, the illustrations are not only original, but also new as to the scope of the various regions presented. The illustrations are unfortunately printed in black only, but notwithstanding the absence of contrast they do illustrate. Some slight coloring would have very materially increased the value of many of the cuts. The diagrams are new and in some instances quite unique. The relation of the viscera to each other and the exterior of the body is given special prominence, and in this respect this book excels all others with which we are acquainted. The descriptions of the bones and joints have been purposely omitted, which we think very proper in a work of this sort.
The index is very complete, occupying thirty pages. As a whole, we believe this work to be really a valuable addition to our list of useful anatomical books and we most heartily commend it to practitioners as well as students. A. I. B.
When Shall We Trephine?
(1) In any fracture of the skull, either simple or compound, when there are symptoms of intracranial mischief. (2) If there is much localized depression, indicating the probability of either immediate or remote quences. (3) In all cases of punctured fracture. (4) For the removal of foreign bodies. (5) In cases of compression of the brain from. blood, pus, or tumor, when the offending cause can be located with a reasonable degree of certainty. (6) In cases of epilepsy, when the traces of the injury originating the disease can be recognized.-Buechner, International Journal of Surgery, May, 1896.
Sir Spencer Wells' Successor.
The Queen of England has appointed Mr. Rickman John Godlie, F.R.C.S., Surgeon to the Household in Ordinary to Her Majesty, in place of Sir Spencer Wells, resigned.
Fracture of Patella.
Dr. Geo. R. Fowler's method consists in exposing the fragments of an intermediate procedure, i. e., after the immediate effects. of the injury have subsided and before ligamentous union has occurred, for the purpose of clearing their surfaces of intervening soft parts, and the application of fixation hooks resembling Malgaigne's, though a single and not a double pair is employed. The incision is made either vertically, transversely, or Ushaped, as indicated, and the hooks are inserted in the line of incision when possible, to avoid separate skin wounds. After carefully removing everything from between the fragments and applying hooks, the parts are stitched with subcuticular silk suture, sterile gauze and cotton are applied, and the limbs are enveloped in plaster-of-paris splints for three weeks, at which time the hooks are removed.-Medical Record.
BOOKS AND PAMPHLETS RECEIVED.
"Tumor of the Cerebellum," by Sanger Brown, M. D. Reprinted from the North American Practitioner, September, 1896.
"Adenoid Vegetations; the Anæsthetics, the Instruments, the Operations; with Special Reference to Operation under Bromide of Ethyl Anæsthesia," by T. Melville Hardie, M. Ď. Reprinted from Annals of Ophthalmology and Otology, July, 1896.
"Electrolysis for the Reduction of Spurs of the Nasal Septum," by W. E. Casselberry, M. D. Reprinted from the Journal of the American Medical Association, September 12, 1896.
"Intubation in the Adult," by W. E. Casselberry, M. D. Reprinted from the New York Medical Journal for September 5, 1896.
"Diagnosis and Treatment of Laryngeal Diphtheria," by W. E. Casselberry, M. D. Reprinted from the North American Practi
"A System of Retaining and Recording Anthropological Data," by William G. Stearns, M. D. Reprinted from the American Journal of Insanity for October, 1896.
Dr. A. C. Abbott, hitherto first assistant, has been elected professor of hygiene in the University of Pennsylvania, in succession to Dr. John S. Billings, resigned.
Officers of the N. A. R. S., 1896-7.
F. J. LUTZ, St. Louis, Mo. 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. Secretary.....
.C. D. WESCOTT, Chicago, Ill. Treasurer..... .......E. R. LEWIS, Kansas City, Mo. Executive Committee:-A. I. BOUFFLEUR, Chicago, Ill., Chair
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.
RELATION BETWEEN THE CLAIM DE-
BY W. B. OUTTEN, M. D., ST. LOUIS, Mo.
We believe with Thoreau, "Duty is one and invariable, requires no impossibilities, nor can it ever be disregarded with impunity."
The true line of duty of the railway surgeon is essentially the same as that of any other honorable man. He should be employed for his true capacity and ability as a surgeon, for this is the cause and the criterion of his merit. The truer the railway surgeon fulfills his vocation as a physician and surgeon, the better, broader and more efficient becomes his service. In the perfection of his knowledge of medicine lies this merit. It can be safely maintained that if his knowledge of medicine is requisite to meet all demands, it can only tend in the direction of science and truth. He should never under any circumstance attempt to occupy a dual position, but preserve unceasingly an honorable, upright individuality as a surgeon and as a man, nothing more. When he essays the function of claim agent or attorney, he ceases to be a surgeon and assumes a function which the nature of his business and training do not fit him for. He can at all times best serve the corporation by which he is employed in the most effective and comprehensive manner by maintaining the just, the true, the honorable. Any service which demands the loss of individuality, the use of falsehood, or dishonest method, will in time engulf and destroy anyone employed in that service. Our actions are not only the formative element of the aggregate of our character, but most frequently the deter
*Read at the annual meeting of the Association of Railway Claim Agents at Pittsburg, June, 1896.
mining factor of our success and happiness. Actions make results and are often not only indelibly pressed upon an individuality, but upon a community or nation as well. The full force of trust and respect only lie in honesty and truth, but there seems to be no limit to the distrust and loss of respect when the reverse is the case. The railway surgeon should never permit his prejudice to thwart his judgment. Partisanship in his position soon leads, not only to loss of respect upon the part of his employer, but of all with whom he may be brought in contact. He should avoid falsehood, prejudice and partisanship; avoid falsehood, because it is the subterfuge of cowards, fools and villains. Prejudice is a fungus-growth causing mental deception and always thrives best in partisanship the jaundiced realm of reason. He should be faithful, sincere, honest and earnest. Faithful, because of the belief in right; sincere, because sincerity is the very soul of conscientiousness; honest, because it is the only true, straight, easily defensible line of action; earnest, as earnestness combines patience and endurance and strength. A truthful, competent, honest railway surgeon is ever a prime, economical factor in railway management. The reverse, a misleading extravagance. The full force of insinuative, plausible. and combative circumstances continuously surround the position of the railway surgeon. It requires judgment, honesty and assertiveness to maintain an upright individuality. It has been very truly said that, "A good character is in all cases the fruit of personal exertion. It is not inherited from parents, it is not created by external advantages, it is no necessary appendage of birth, wealth or station, but is the result of our own endeavors." The railway surgeon's duty is at times fourfold. His duty to himself, to his patient, to his employer and to the community. If he is true to the first two duties, the two last will never suffer. The railway surgeon's duty then is one and invariable; hence it can never lean in the direction of crime, neglect or falsehood, but only in that direction which honest function demands and carries in its very core the golden rule of action. Nothing in the shape of an organization needs and appreciates truth more than a railway corporation. The most effective and successful executive in any management has made more of a success by the use of his knowledge of a true and honest man than he has by too deep a
study of the rascality and duplicity of the dishonest. This may sound like balderdash, but investigation will verify this assertion; a knowledge of whom to trust is pre-eminently the basis of all executive work and management which bears the stamp of success. "Rem acu tetigesti" truth, when it is said that all competent and discerning men prefer honesty, with its efficiency and certainty of action, to dishonesty, with its doubtfulness and equivocality. From the standpoint of expediency, if no higher motive is suggested, truth and honesty give more complete and perfect comfort to existence than the reverse. It may be true that nothing is impossible, but we maintain that the successful hiding of a lie in the guise of truth has been an impossible task to the most brilliant intellect ever created. Honesty is almost consequently associated with good sense and judgment. Dishonesty is in a great many instances the result of defective mentality. There is nothing, as a general thing, impossible in the performance of duty; but a duty neglected may partake of fraud, dishonesty and criminality. The true line of duty of the railway surgeon, then, must consist in honest, effective knowledge of his function, along with the true, exact and strict performance of the same. Experience and result have taught millions before us and will teach millions yet to come-that duty, honesty and truth are forces which most broadly and constantly rule the intellect of man, and that the highest success and happiness in life comes through their effects and practice. The relationship which should exist between the railway surgeon and the railway claim agent is pertinently expressed in this assertion: That truth should be the object of their understanding and there need never be any abrogation of truth. The position of a claim agent upon a railway is by every element constituted an honorable position, and as such, can be constantly main tained. An effective claim agent must of necessity be an intelligent man of rectitude and deep conviction. He can at all times honorably maintain his function and is never called on to assume unmanly function, nor assume the role of detective or brow-beater. The surgeon's line of work is entirely in the domain. of the humane; in plying the true nature of his vocation, he is of constant assistance to the claim agent, as he truthfully gives a clear and honest statement of the physical condition of