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usefulness of the parts should invariable be given precedence, whereas in those whose occupations do not entail any danger the cosmetic effect should very properly be given full consideration and under some circumstances even to the extent of saving useless members.
The Northern Pacific Hospital at Missoula.
The last issue of the Railway Age says: The Railway Age is a thorough believer in the advantages of a properly organized sur
the need of special hospitals for the employes of the companies is less apparent, but in the east also the railway hospital is gaining ground, and it is unlikely that in the near future any railway of any considerable size will be without its own hospital and its own corps of surgeons, under the direction of a chief surgeon, who should be as much an officer of the company as the general superintendent or the chief engineer. The work which has been done and is being done by the National Association of Railway Surgeons has gone a long way to impress on railway men in general the importance of this branch of railway
gical service on a railroad, in the hospital system and in beneficial and relief associations. If the three can be combined in one organization so that the employes who are members of the relief or beneficial association have some voice and ownership in the management of the hospitals, so much the better. Most of the larger companies of the west know by experience the advantages of having their own hospitals, for it is an advantage to the company as well as a blessing to the men. On eastern roads which, for the most part, run through well populated districts where adequate hospital facilities are always at hand in the frequent towns along the lines,
management, just as it has impressed on the medical profession the right of "railway surgery" to be regarded as a distinct department of surgical science.
One of the prosperous and well regulated beneficial associations of the country is that of the Northern Pacific, the chief hospital being located at Missoula, Mont., under charge of Dr. J. J. Buckley. We give an illustration of the hospital building herewith. In a letter to the editors of The Railway Age, written at the end of September, Dr. Buckley said: "I only regret that I cannot show you the beautiful grounds filled with flowers and surrounded by fine trees."
The American Association of Obstetricians and Gynecologists, at its ninth annual meeting, held at Richmond, Va., elected the following named officers for the ensuing year, namely: President, James F. W. Ross, M. D., Toronto; vice-presidents, George Ben Johnston, M. D., Richmond, and John C. Sexton, M. D., Rushville, Ind.; secretary, William Warren Potter, M. D., Buffalo; treasurer, Xavier O. Werder, M. D., Pittsburg. Executive council: Charles A. L. Reed, M. D., Cincinnati; Lewis S. McMurtry, M. D., Louisville; A. Vander Veer, M. D., Albany; J. Henry Carstens, M. D., Detroit; and William E. B. Davis, M. D., Birmingham.
The next annual meeting was appointed to be held at the Cataract House, Niagara Falls, N. Y., Tuesday, Wednesday, Thursday and Friday, August 17, 18, 19 and 20, 1897.
"Treatment of Inoperable Malignant Disease by Hypodermic Injection of Erysipelas and Prodigiosess Toxines-Peritonitis," by Dr. J. A. Weitz, Montpelier, Ohio.
"Abscess of the Liver After Appendicitis," by Dr. H. C. Howard, Champaign, Ill.
Papers promised but titles not sent to the secretary, by Dr. R. Gillaspy, La Plata, Mo. Volunteer papers and report of cases, by Dr. W. R. Schussler, Orland, Ill.
Prophets Not Without Honor.
The Medical Record reminds us that when the Crown Prince Frederick of Germany was suffering from carcinoma of the larynx, he sent to England for a laryngologist; that when the Czar of Russia was ill he had his own physician, but sent to Berlin for a consultant, and says that now Queen Victoria is suffering from failing vision and has sent to Germany for an oculist, Doctor Pagenstecher of Wiesbaden, to examine her eyes. It is said, in explanation, that there is a pamphlet in circulation in which many of the leading oculists in England are spoken of in disparaging terms, and it is intimated that the Queen is influenced by that to send abroad for advice.
Carrier Pigeons in Medical Practice.
A doctor in the highlands of Scotland, whose patients are scattered over a wide district, takes carrier pigeons with him on his rounds and sends his prescriptions by them to the apothecary. He leaves pigeons, too, with distant families, to be let loose when his services are needed.-Chicago Medical Recorder.
Notes, News and Personals.
It is with sincere regret that we chronicle the death of our distinguished fellow and ex-president, Dr. James Bissett Murdock of Pittsburg, Pa. He died at his home October 29. He was born in Glasgow, Scotland, October 16, 1830, and was therefore 66 years of age. He graduated from the New York College of Physicians and Surgeons in 1854 and was an interne in Bellevue Hospital. From 1855 to 1872 he practiced at Elmira, N. Y., the home of his father, the Rev. David Murdock, D. D., but since that time has lived and worked in Pittsburg. He was a member of the Oswego County Medical Society and was its president in 1865; of the New York State Medical Society; of the Allegheny County Medical Society; of the Pittsburg Academy of Medicine and School of Anatomy, of which he was president in 1877; of the Pennsylvania State Medical Society, of which he was president in 1888, and of the American Medical Association. He was president of the National Association of Railway Surgeons in 1889. During the War of the Rebellion he was brigade surgeon-inchief in the Twenty-fourth New York Volunteers. He was a member of the Grand Army, of the Loyal Legion, a trustee of the Pennsylvania College for Women, and late Dean of the Western Pennsylvania Medical College. He was a frequent contributor to medical literature and wrote well and wisely. We hope to publish a fitting obituary later.
The Wabash Railway Company has just completed a new hospital at Peru, Ind., of which it is very proud. It is of brick in the form of an octagon with wings, covering an area of 198x123 feet. It is two stories in height with an observatory and tower. The hospital will accommodate 100 patients, and aside from the usual hospital appointments is provided with reading rooms and reception rooms for the use of the patients and their friends.
Commendable Testimony in a Malpractice Trial.
The Wiener Klinische Rundschau for August 16 summarizes an account of a malpractice case from a journal that it calls "N. Fr. Pr.," which may or may not mean Neue Freie Presse. It appears that the physician against whom the action was brought had been called to attend a woman in childbirth, and had undertaken some operation which he considered necessary, but had found himself obliged to leave it unfinished and send the patient into a hospital. There an operation was performed and the woman died on the following day. At the post-mortem examination a laceration of the internal organs was found, also a foul canal, and it was concluded that the
injuries had been inflicted with the forceps. In the complaint the physician was charged with having displayed lack of skill in the operation.
Two expressions of opinion, says the account, were of noteworthy weight in the case. On the strength of Professor von Hofmann's necropsy, the judge held it to have been shown that the woman's injuries must have been inflicted before she entered the hospital, and that the physician's operative procedure was not in accordance with the rules of the obstetric art. Professor Schauta gave expert testimony as follows: "The first question is that of whether the operation was indicated, and to that I must answer yes. In this case I should have done the same thing myself; it accords perfectly with the rules of obstetrics. This I must maintain here in direct opposition to Professor von Hofmann's opinion. The woman's physician, to be sure, inflicted the injury with his instrument. But now comes the question, Is that pardonable or not? As to that, I must say that apparently the instrument deviated from its position in consequence of some slight movement on the part of the patient. The circumstances of private practice in such a case are peculiarly embarrassing. In hospital practice we anesthetize the patient and she lies perfectly still. In this instance, however, there was no assistance but that of the midwife. I may remark that all of us, from the first to the least, are often so situated as to have to say with regard to mishaps: Something has happened that might have been avoided. There are disastrous occurrences that are due to the extraordinary difficulties of obstetrics. The present case was one of misadventure, and surely it is not to be attributed to the physician's negligence or ignorance."
The Rundschau commends Prof. Schauta's testimony from every point of view, and so do we.-N. Y. Medical Journal.
Strangulation of the Penis by an Iron Screw-nut.
Weinlechner (Wien. klin. Wochenschr., No. 24, 1896) reported to the Vienna Medical Society the case of a boy of 14, who, having passed his penis through the lumen of a screwnut two days before admission, had been unable to withdraw it. The peripheral portion was much swollen, and the foreskin very œdematous, but micturition was not arrested. The hexagonal nut was 3.2 cm. in diameter by 2.3 in thickness, the lumen was nearly 2 cm. across. His father had tried to remove it with a file.
Four greased strips of linen were passed through the nut on four sides of the hexagon, and by traction on these while the central end of the organ was kept steady the nut was drawn off. The excoriation and swelling soon disappeared.
Extracts and Abstracts. method is the fact that no pockets of necrotic
tissue are closed in by the new skin, as sometimes happens in grafting by the Thiersch method. Le Semaine Medical.
Epithelial Sowing; A New Method of Skingrafting.
F. von Mangoldt (of Dresden) has conceived a method of skin-grafting, to which he has given the name of "epithelial sowing," which, for ease of execution and certain other advantages, merits careful consideration.
The epithelial elements are obtained by simply scraping a healthy cutaneous surface.
For this purpose he prefers the external or internal surface of the arm. The chosen spot is carefully shaved and disinfected and then, with a sharp sterilized razor, held perpendicularly to the skin, the epidermis is scraped away until the papillary layer is reached. In this way a magma is obtained, composed of epithelial cells and extravasated blood, which is spread upon the surface to be treated and thoroughly pressed in with a spatula. This sowing is very simple in case of a fresh wound, provided that the blood has ceased oozing; but in case of an old or infected wound it is necessary to remove the granulations and thoroughly disinfect it.
Nerve Suture and Regeneration.
At a recent meeting of the College of Physicians of Philadelphia, Dr. Thomas S. K. Morton presented a man, aged 34 years, who was admitted to the Pennsylvania Hospital, August 10, 1895. His left arm had been caught between a revolving wheel and its belt. An extensive crush and laceration had resulted. There was a wound of the inner aspect of the arm running from elbow to just below the axilla. The biceps was almost cut through, so also the triceps and brachialis anticus. The brachial artery was torn, the ulnar nerve cut across, and about two and a half inches of the median nerve stretched tightly across the wound free of all support save its sheath. A large chip of bone was bitten out of the inner aspect of the humerus. The main wound connected with a smaller one on the outer side of the arm. There were also several smaller wounds about the larger ones, and the whole extremity from axilla to nearly the wrist was much contused and "brush-burned." The arm below the wounds was perfectly cold and white and possessed no sensation except of the feeblest character in the median distribution. There was no radial or ulnar pulse.
Amputation was advised, but peremptorily rejected by the man and his relatives. Therefore, under ether, the wound was cleansed of considerable machine-oil and other foreign bodies; ends of frayed muscles and skin dissected away; the upper and lower ends of the brachial artery sought for and ligated; the torn. muscles partially approximated by catgut sutures; the ulnar nerve carefully sutured with the same material; the whole cavity sponged out with 1:2,000 bichloride solution and then gently stuffed with iodoform gauze. No attempt was made to suture the cutaneous wounds. The arm was then done up in a copious gauze dressing wrung out of hot sublimate solution and placed under irrigation of the same in a position of slight flexion at the patient's side, while cotton batting and hotwater bags were kept constantly applied to the forearm and hand.
On August 12 the forearm had warmed up, and on the day following irrigation was suspended. On the 19th a feeble radial pulse could be distinguished and sensation in the ulnar distribution was fair. Wound had begun to rapidly fill with granulations. The exposed sheath of the median nerve had become covered with a mass of red granulations starting from its emergence from the tissues above and below the exposed portions. These increased
in bulk to half an inch in diameter and ultimately blended with those arising from the deeper portions to the height of the nerve bridge across the chasm of the wound.
Improvement continued uninterruptedly, and toward the end of September the wound finally closed. The cicatrix, while very large, does not at the present time interfere with free flexion and extension of the arm, although at one point attached to bone. The biceps and triceps are fairly strong and increasing in power. Sensation in the median distribution is perfect, and in the ulnar almost so and still improving.-Annals of surgery.
Old Dislocation, With Fracture of the Neck of the Humerus.
At a recent meeting of the New York Surgical Society, Dr. B. Farquhar Curtis presented a boy, fourteen years of age, on whom he had operated four weeks after an injury resulting in dislocation of the shoulder with fracture of the neck of the humerus. The injury had taken place in November, but its severity was not understood, and until he saw the patient the treatment had consisted simply in putting the arm in a sling. Dr. Curtis found the head of the humerus dislocated below the coracoid process, and the surgical neck fractured. The arm was almost painless, but there was great limitation of motion. The elbow could not be raised from the side at all, scarcely any rotation was possible, slight antero-posterior movements alone could be made voluntarily at the shoulder-joint. Passive motion was somewhat more extensive. He made an incision, three or four inches long, vertically downward from the acromion, opening the capsule and exposing the head of the humerus. With a hooked instrument, like one described by Dr. McBurney, inserted into a drill-hole made in the upper fragment, he tried to replace the head, but the bone was too soft, the hook tore out so that the head could not be moved in this man-ner. He was, therefore, compelled to divide capsular bands freely wherever there seemed to be any tension, and by means of blunt instruments used as levers and with his fingers was finally able to force the head into the glenoid cavity. The shortening was considerable-two inches-the fracture was transverse, and he found it impossible to bring the fractured ends into correct apposition until he had removed about half an inch from each fragHe then had broad bony apposition. The head of the bone was rotated inward, and as he could not rotate it outward he put the arm up in inward rotation, too. This explained why there is now greater inward rotation than normal, and outward rotation is limited. Primary union was obtained in ten days, slight passive movements were begun on removing
the dressing at that time, and were practiced more freely and systematically after three weeks. At present he could lift the arm fortyfive degrees from the vertical without motion of the scapula, and was constantly gaining. The attempts to secure motion had been interrupted for two or three weeks after he left the hospital by an accident to the elbow caused by a fall. It is now three months since the operation, and the functional result is excellent.-Annals of Surgery.
A Rare Sequela of Head Injury.
Gleich (Wien. med. Wochenschrift, May 23, 1896) records the following case. A man of 48 fell from a wagon and was run over; he did not recover consciousness till on the way to hospital, when he had no recollection of the accident, but appeared to have been drinking. There were two contused and incised wounds, one in the occipital region 1 inches long, but not reaching the bone; the other half the length, and implicating the auricular cartilage; both were covered with mud and filth. The pulse was 56, and there was some paresis of both upper extremities. The scalp wound healed readily, that of the ear suppurated; the pulse improved, but the appetite was bad, and the patient became weaker. Four weeks after the accident, the ear wound being almost well, the man had a sudden rigor, with temperature 103.4 degrees Farenheit and pulse 80. There was pain over the temporal muscle, and slight swelling above and behind the mastoid process, with slight facial palsy and pain and limitation of movement in the neck. Next day the symptoms had somewhat improved, but he was still quite apathetic; the ear wound was apparently well. Sinus thrombosis or cerebral abscess following mastoid suppuration was diagnosed, and the mastoid was opened, 15 to 20 drops of thick pus escaping. The dura mater was apparently healthy, but as it showed neither pulsation nor respiratory movements, and area the size of a shilling was exposed without anything further being revealed. Nothing more was done, as it was considered that should fresh symptoms arise an extension of the wound would be very easy. Recovery was uninterrupted, and four days after the operation pulsation of the sinus and respiratory movements of the dura were observed for the first time. The patient, who had previously been morose, became cheerful, and though healing was slow, he was, at the time of writing, well except for slight paresis of the left upper arm. Gleich comments on the rarity of infection of the mastoid from a wound of the ear, and adduces this case as an instance in support of Bergmann's dictum that the limits of a cerebral operation should be not the skull bones, but the healthy dura.