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CONTENTS OF THIS NUMBER.
Address of Welcome to the Ninth Annual
CHICAGO, JUNE 2, 1896.
Surgery of the Spinal Cord and Column-
NOTES OF SOCIETIES:
Some Psychic Conditions Immediately
Pathogenesis of Uræmia..
National Association of Railway Surgeons 19
Officers of the N. A. R. S., 1895-6.
GEO. GRAVES, Herkimer, N. Y.
.P. F. VASTERLING, St. Louis, Mo.
ADDRESS OF WELCOME TO THE
BY DR. M. C. STARKLOFF, HEALTH COMMIS.
Gentlemen of the National Association of Rail-
Impressed with the honor which has been
Recently, in looking over the surgical litera-
given it by the combined influence of the medical profession, that there is no cure for any disease, no single remedy, no happy combination of remedies for any disease which has ever affected humanity." That is to say,— that medicine and surgery in all the years from Esculapius to that time had not advanced to the dignity of a science, but remained a simple art, based upon the empirical observation of what was good or bad for men. What can 1896 answer back to this grave utterance? What has the last half of the present century done for surgery? Let us review, briefly, the history of these few years, so full for the welfare of mankind.
Dr. R. B. Carter, in a paper on medicine and surgery, in "The Reign of Queen Victoria," says: "The anaesthetic age has changed the whole aspect of surgery. Prior to 1847, surgical operations were few in number and almost limited to the amputation of limbs, the removal of cancerous growths and other tumors, the resection of a few of the larger joints, cutting for stone, and the ligature of main arteries for aneurism. The pain suffered by patients was so great as to tax severely the endurance of the bravest and strongest and to depress seriously and beyond recall the powers of life. Death from shock was by no means uncommon, the patient sinking in a few hours from the actual suffering that he had undergone. It was a point of honor with. surgeons in those days to abbreviate such agonies as much as possible and to cultivate mere speed in operating, as the highest and most valuable form of dexterity. Nothing was attempted which could not be done quickly, and an amputation, in the hands of a skilled surgeon, had almost the appearance of a feat of legerdermain. For the separation of a lower limb above the knee (of course not including dressing), twenty seconds have been known to suffice, while forty seconds was regarded as a period of time which no man was justified in exceeding."
In 1847 the anaesthetic age commenced. How sternly does this discovery teach that man must earn every boon from nature by his own incessant striving! And how strange that the simple chemical and physiological secret of ether should have hidden so long in its easy formula, undiscovered through all these waiting centuries, when pain was the
omnipresent tyrant, which science could not control. Ether and chloroform had the key, but not until many years afterward did the hand of a citizen of the United States, an American dentist, Dr. Jackson, fit it into the golden doorway behind which sat waiting an angel of pity, kinder, more beneficent and more powerful than an Arabian fairy ever suddenly revealed in her divine beauty and bountifulness, to any prince or magician of the thousand and one tales.
To surgery, anæsthesia gave a sure control of anguish. To the surgeon, confidence, quiet, leisure. It came like a revelation to surgeons, that they need no longer be in such a frantic hurry. To those who have to be under the knife, it gives a sweet and complete oblivion; a world of "black velvet" tranquillity, of which these magic drugs keep unbounded store; and to awake grateful beyond words for the soft spell of peace. Anæsthesia gave a sure control of pain and robbed the operating room of its terrors, but afforded no help in the healing of wounds.
In 1858 the great French scientist, Louis Pasteur (to whom surgery owes a lasting debt of gratitude), began his memorable battle against the fallacious doctrine of spontaneous generation, and by its overthrow in 1860 he laid securely the foundation of the modern science of bacteriology. In 1865 a young surgeon in one of the Edinburgh hospitals was the first to see the vast merits of Pasteur's bacteriological labors. His practical mind, instinct with genius, seized upon and closed with the conception that the healing of wounds was prevented by the entrance of micro-organisms into them. Touched by this wand, difficulties fell before him. He began his great battle for antiseptic surgery that has in so short a time changed the whole aspect of surgery and led to such marvelous and beneficial results. This young man is now the venerable Sir Joseph Lister, whose splendid achievements have lighted up the dark places of surgery and transformed the treatment of wounds from a matter of uncertainty, and too often disastrous empiricism, into a scientific art of sure beneficence. Thanks to him, surgery has undergone a complete revolution which has deprived it of its terrors and extended almost without limit its efficacious powers.
To no class of surgeons do the benefits of
these discoveries appeal with greater force than to railway surgeons. Surgery, being the most practical of the medical sciences, necessarily attracts to it the cream of the medical profession, the greatest intellects, the greatest manipulative skill. In welcoming you to this city, gentlemen, I know that I am addressing the cream of the medical profession of this country.
BY HON. ALEX. G. COCHRAN, GENERAL SO-
Mr. Chairman, ladies and gentlemen, and members of the National Convention of Railway Surgeons: It affords me a great deal of pleasure to be with you to-night, and I very highly appreciate the honor conferred upon me by the invitation of your committee to address this distinguished assembly.
The newspapers stated that I was to deliver an address. I do not like the word "address," for somehow or other I always find that when I have anything to say I can always say it so much better if I can take men by the hand, look into their eyes and talk to them in the ordinary, everyday manner. That is the way I would like to feel toward you tonight. I know that all real good lawyers are good fellows, and I have no doubt that you will agree with me in saying that all good surgeons are good fellows, too. I have come here to-night in a quiet, unostentatious manner and shall not attempt any oratory, but just simply look at you and give you an informal talk.
It is a pleasure to me to look into your intelligent faces, and I want to speak to you just as if we were sitting down and having a conversation. You are railroad surgeons, I am a railroad lawyer. I have always felt that the professions of the law and of medicine were nearly akin. They are both splendid professions, requiring the strongest intellects and the greatest and closest application and labor. They are both professions with the highest possible standards, and there is no time, however long we may be spared to live upon this earth, when any man, who is a member of either profession, will be prepared to say that he knows all about it. On the contrary, it seems
*Delivered at the Ninth Annual Meeting of the National Association of Railway Surgeons at St. Louis, April 30, 1896.
to me that the older we get, and the more knowledge that we acquire, the less we feel that we know about the great subjects to which we have devoted our lives. In this connection I desire to briefly relate a little incident which occurred some years ago. A young man, who had just graduated from the Harvard Law School, and lived in New York, was on his way home, and, of course, felt that he was a big man. He had his sheepskin in his pocket. His professors had shaken his hand and bade him God speed in going out into the commercial world. As he got on a boat at Fall River, he noticed on deck an old judge, a man who had known him from boyhood and was a great friend of his father. The young man went up to the judge, took him by the hand, and said: "Judge, I am all through studying law." "Well, now," the judge replied, "permit me to congratulate you. I have been studying law for upward of fifty years, and I feel that I have only just commenced."
When I remember the marvelous advances that have been made in surgery and medicine, even in the short span of my own life, I am almost appalled. When I was a boy the standard prescriptions for most ills for grown people and children were Dover's powders, castor oil and turpentine. (Laughter). I went through that treatment two or three times myself. Look at the progress medicine has made since that time! It has not come by accident. Far from it. It has come by your patient labor day and night, through months and years of the toiling men of your profession, who have bestowed the untold blessings upon humanity which they enjoy to-day. And yet with all your knowledge you have just simply picked a little of the surface, for beneath lies the great mine of wealth which is yet to be uncovered and shown to the world. This is true of law also, but eminently true of medicine. and surgery. Take the new medicines that have been discovered. Think of all those wonderful medicines we have now, the products of coal tar. Think of cocaine. Look at the various other medicines which I cannot enumerate here, but which are familiar to you and have become known to you only in the last few years. Take surgery. Many of you remember the time-I remember it well-that when a man was known to have a wound of the intestines, the wisest and most skillful sur
geons shook their heads after examining him, saying that the man has not one chance in a thousand to get well. During those days patients died from gunshot wounds of the abdomen. There was no hope for them; and yet to-day your medical journals and text books are full of the most wonderful resutls obtained by that wonderful discovery of what you call antiseptic surgery. In this connection it gives me great satisfaction and gratification to say that no greater honor is due any man, in the treatment of intestinal wounds and of intestinal obstruction, than to your distinguished president, Dr. Murphy. (Applause.)
I must not suffer myself to wander into these general fields of thought, because I do not want to occupy your attention for any great length of time. I want to make my remarks comparatively brief, and consequently I shall talk to you for a few minutes about the question of railway surgery and the connection between the departments. You are railroad surgeons, and we have upon the stage to-night a gentleman whom it has been an honor for me to know and to be associated with, who is at the head of the surgical and hospital department of the great system of roads with which I have the honor to be connected. What a blessing it has been to the great mass of employes engaged in the dangerous duty of railroading, to establish surgical departments on the various roads. Just think for a moment of what the condition of these poor boys would be if you withdrew this blessing from them. A train is running along through the country; there is a derailment, a collision, an accident of some kind. A poor fellow is thrown from the car, is crushed and bleeding. What are we to do with him? Who are we to communicate with? Probably the doctor at the nearest point, and very likely he is an insignificant doctor in railway surgery, because it is the exception, as we all know, to find a man who has devoted the attention, care and thought to surgery which are necessary for him to make a first-class surgeon. The country doctor may be a very estimable man, but unacquainted with such matters as these. The injured man may be taken to the nearest country hotel, or perhaps to the house of some good Samaritan, who takes him in, and then the country doctor with his medicines and appliances will try to treat the case. He
is almost as helpless in following the treatment of the case as is the poor miserable wretch, who lies crushed and mangled before him. That used to be the case in years gone by. I know it was the case when I was a boy. But now that has all been changed. From the rank and file of surgeons and physicians you select men of peculiar ability. You select them because of their brains, their courage and intelligence, and who have been associated and connected with this vast network of roads which extend from the Atlantic to the Pacific. What is the result? A man is injured. What shall we do with him? We will send him to Dr. So-and-so, our surgeon. The mere fact of saying that Dr. So-and-so is our surgeon is a sufficient guarantee of the competency of the man. The matter is attended to quickly. A car and engine are hastily run, a surgeon is summoned, who instantly understands the character of the wounds. He knows what is necessary to be done in order to alleviate the suffering and save the life, and the Missouri Pacific Company and some other companies have done what I yet hope to see every railroad in the United States do, and which I believe every railroad in the United States will yet do, namely, establish in connection with their surgical department a splendid hospital service. (Applause.) We have a place for our injured; we do not need to take our patients to country hotels; we do not need to take them into the room of some good Samaritan who throws his house open; we do not need to take them to a partially furnished hospital, or one where the patient is not able to receive the careful attention which the seriousness of his case demands. I understand that when one of the employes of our road is injured, he is at once conveyed either to our great hospital here in St. Louis, or, if it is nearer, to our hospital in Kansas City. And when he gets there, what does he find? A perfectly fitted up establishment, presided over by brains; by men who have consecrated and devoted their lives to taking care of men who have been injured in the railway service. We have a chief surgeon with all the accumulated judgment of years, competent assistants in the hospital, and every appliance for proper treatment and every medicine that is needed-in short, we have a perfect and complete establishment, surrounded by trees, greensward and flowers,
and the sufferer may glance out of the window and lift his eyes to the azure blue above him. There he is kept and the United States can give him no better attention than is given him in this hospital. Every need is supplied and in his agony he has the most competent nurses to minister to his wants and to relieve him. He is kept there until he is well. This splendid hospital system is maintained by the slight contribution of the many men who are employed in the service, extending from the highest officers down to the men who receive the lowest salaries-just a small, trifling annual contribution maintains our hospital system. Gentlemen, I speak of it because I know of it, and I express again, for the purpose of emphasis, the hope that the day is not far distant when every great system of railroad in the United States will have adopted this policy.
I am pleased to say to you in this connection and Dr. Outten will pardon me for making a remark in reference to the matter, which was the result of correspondence entirely with himself that within the past year or two many inquiries have been made of Dr. Outten as to our system from some of the strongest roads in the East. I believe this system will yet prevail throughout this country. (Applause.)
I will touch on another thought. There was a time when the railroad surgeon was supposed to be a man paid to give testimony for the company that employed him. That was the general idea. We have got our lawyer and he must fight our case, and we have got our doctor and he must fight it, too, no matter what he thinks. He has no right to think. That was the general idea that prevailed in years gone by. How glad I am to know that this idea has disappeared. It no longer remains, and to-day the men who occupy positions as surgeons of these roads are men of the highest intelligence and highest character, and I want to say this, that there ought to be the closest interest and friendship existing between the legal and surgical departments of all these systems. No railroad is complete without its surgical department. Some say: "Can you not do without it?" Can you do without your hand? Can you do without your leg? Of course, you can get a wooden leg, but you are far from being a per
fect man when you are maimed and crippled in that way. This is the case with a railroad without its surgical department. If you want to make it perfect you have got to have a surgical department, just as much so as a claim department or a law department. I take it, that we are all brothers in this matter, all working together for a common cause, for the good of the system with which we are connected and associated. There not only ought to be confidence and great friendship existing between the legal and surgical departments, but our entire relations ought to be founded upon one simple little word which we hear so often-truth. The utmost truth should prevail at all times. For instance, here is a man who is hurt; he brings a suit against the railway company for twenty-five thousand dollars. When I have such a case, my first impulse is to send for Dr. Outten, and I say to him: "This man is in your hospital. You have had him from the beginning and have treated him?" "Yes, sir," "You have examined his case and taken note of his symptoms from the beginning?" "Yes." He claims to be suffering from permanent injury; that he has railway spine or something of that kind, which condition is not visible, but which he says has paralyzed him. He says he cannot move, cannot eat, or do anything, and he thinks $25,000 would be a small sum. I ask Dr. Outten what he thinks of this case. I want to know what value Dr. Outten would be to me or his company if he turned to me at once and said there was nothing the matter with that fellow, if there was really something the matter with him? If he is paralyzed, or permanently injured, I want to know it. I want simply to know the truth, because I cannot act intelligently unless I do know it.
When a patient comes to you, you ask him a great many questions, how he is affected, whether his head aches or not, whether he has difficulty in breathing, etc.? If the man lies to you, you cannot diagnose his case, and you are apt to give him the wrong remedy. You want to know what is the matter. If Dr. Outten informs me that there is nothing the matter with the fellow, I advise my company, basing my opinion on the expert testimony given by Dr. Outten. I say to my company, that this claim is outrageous; that the man was injured to some degree and is