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It will be remembered that the selection of the time and place of the next meeting of the National Association of Railway Surgeons was, by vote of the members present at the St. Louis meeting, left to the Executive Committee. After due consideration of the merits of the several cities suggested it was thought that the relative ease with which a large majority of our members can reach Chicago should carry great weight in the determination of the place of meeting. It has therefore been decided that the tenth annual convention will be held in this city, May 4, 5 and 6, 1897.

While there is every reason to believe that the coming meeting will be successful from every point of view, it must not be forgotten that the measure of success depends directly upon the individual interest and activity of the members and officers of the association. There is much to be done in the five months intervening and every member can do something to contribute to the general interest

and practical value of the meeting. Every officer is expected to prepare a paper and to induce his friends to contribute to the scientific work of the sessions. Every member is invited to prepare a paper, report a case, show a new instrument, device or dressing, or suggest a topic which he would like to hear discussed.

There is still ample room for original research concerning numerous problems in traumatic surgery, and we shall hope to have papers descriptive of further studies in the suture of vessels and nerves, the healing of ununited fractures, new methods of wound treatment, etc.

The question of the best methods for determining the practical ability of trainmen to distinguish colored signals is by no means settled, although it has been wonderfully cleared up by the work of members of our association.

We would also suggest the discussion of the following subjects:

Concussion of the Brain vs. Concussion of the Spine.

Railway Injuries of the Various Regions of the Body.

Hospital and Relief Departments. The Relation of Railway Companies to State Boards of Health.

What are the normal relations of employes to railway companies and what can the National Association and we, as surgeons, do to bring them about?

The Aims and Purposes of the National Association of Railway Surgeons and the Result of its Work.

Let those who will contribute to the program of the next meeting begin at once to prepare. The leisure moments of five months in the lives of most busy surgeons are not too many for the thoughtful preparation and boiling down of such papers as should be presented at the meeting of the National Association of Railway Surgeons. And the boiling down should not be neglected. It is truly an imposition to ask several hundreds of intelligent surgeons to listen for twenty minutes to the reading of a paper all the points of which can be stated with equal clearness in ten or possibly five minutes. Therefore let us, in the preparation of our contributions, be ever thoughtful of those who will listen or

read. Let us thresh no old straw unless we can demonstrate the presence of undiscovered wheat. Let us take no time in giving non-essential details in reporting cases, but at the same time let us not sacrifice smooth and correct English for the sake of using few words.

Without in the least reflecting upon the work of those who have contributed to previous meetings, we are proud to say that the papers read at the last two meetings of the association show a marked improvement both in scientific and literary worth, and it is unquestionably true that the success of a paper depends much upon the clearness and terseness of the language in which it is written. Short sentences, built of good old AngloSaxon words, cost the least and go farthest.

Operation During Shock.

Dr. W. L. Estes of Bethlehem, Pa., has an excellent article in the International Journal of Surgery upon the above subject. He concludes his paper thus: "The method and manner of anesthetizing are also important matters. Both of the commonly used general anæsthetics, ether and chloroform, I have found weakening. To reduce this effect to a minimum, it is important to employ small doses and to continue the inhalation as short a time as practicable. In order to facilitate this I have found morphine, given in a moderate dose, hypodermically, ten minutes before the anæsthesia is begun, to be a very reliable and valuable agent; it materially assists in the anæsthesia and markedly lessens the quantity of the anaesthetic required. The manner of giving the anaesthetic is also important. Forcing and smothering ought to be sedulously avoided. Whatever cone is used, it should be borne in mind that in these weak conditions a liberal admixture of air is necessary. The degree of anesthesia should never be profound, but simply to the stage of loss of reflex and partial relaxation. The anesthetic should be entirely discontinued as soon as the suturing of the stump is begun. Usually, with the use of morphine, the state of anesthesia continues long enough for the operator to comfortably place and tie his, sutures."

We are very sorry to know that that brilliant operator and distinguished teacher, Dr. Howard Kelly of Johns Hopkins University, has been ordered into a year's retirement from all work pertaining to his professional life, because of overwork and worry. Dr. Kelly is now in the far West, and we sincerely hope he will regain his former vigor.


The following interesting letter has been received by the editor:

Associated Physicians and Surgeons of Santa
Clara Valley,
Dr. A. Jayet, .

Dr. Lincoln Cothran,

San Jose, Cal.. Nov. 18, 1896. Dear Sir: We ask you to give publicity to this letter and accompanying resolutions, to the end that in all communities afflicted with the pestiferous practice of lodge doctor-. ing, physicians may be encouraged to assert their independence through organization.

Here, in Santa Clara county, Cal., containing 70,000 population, all the physicians of the county, numbering 124, have entered the compact that has ridden us of a slavish evil, and wrought independence and freedom for the practitioners of medicine. Investigation shows that medical compensation for lodge work averages about 15 cents on the dollar.

Even respectable lodge physcians feel a sense of degradation in giving their services for 15 cents on the dollar, and the ever-increasing spread of these alleged charitable institutions is absolutely destructive to the business of other physicians.

The main incentive of the persons who band themselves together in lodges is to get cheap doctoring. They are willing to take but not to give. They belong to protective unions, and the same right should not be denied physicians. Ninety-nine per cent of these people are able to pay reasonable fees to physicians, but will not do so as long as a few doctors in every community for the sake of immediate gain can be induced to stand as driven guys to the lodge politicians. No preacher or lawyer would give his services to these people for 15 cents on the dollar. No grocery store or merchandise firm would contract to supply these lodges with goods at 15 cents on the dollar of actual worth.

The remedy indicated in the subjoined resolutions is simple, and manifestly efficacious, depending upon the personal honor and free will of those concerned. Where one doctor temporarily profits by contract work the business and ethical rights of fifty others are violated. Hence an overwhelming esprit de corps is created among physicians which will sustain a strict observance of the pledge.



Whereas, Rendering professional services at a stipulated fee per capita per annnum is derogatory to the dignity of the medical pro

fession, we, the undersigned physicians and surgeons of Santa Clara county, California, enter into the following agreement:

First. We mutually, jointly and individually, pledge our word of honor not to enter into any contract or agreement, or renew any existing contract or agreement, either written, verbal or implied, to render medical or surgical services to any lodge, society, association or organization.

Second. We will not render medical or surgical services to the members of the above mentioned bodies for less compensation than we charge the general public for similar services.

Third. This agreement shall not be construed to affect existing contracts between physicians and surgeons and the above mentioned bodies.

Fourth. These pledges shall take effect and be in force for a term of three (3) years from and after May 22, 1896.

This agreement shall not apply to hospitals and purely public charitable institutions.

The resolutions have been signed by about 135 physicians of San Jose, Santa Clara, Los Gatos, Palo Alto, Mayfield, Mt. View, Morgan, Hill, Gilroy Saratoga, Agnews, Campbell, Milpitas and College Park.

A standing committee has been appointed whose duty shall be to interview new coming physicians, etc., and, in general, to carry out the purposes of the agreement. Communications may be addressed to the chairman or secretary.

Notes of Societies.

The sixth annual meeting of the New York State Association of Railway Surgeons was one of the most successsful in the history of the society. While all the papers were excellent, those by Drs. Roswell Park and Frank H. Caldwell were the papers of the day. At the executive session a resolution was unanimously adopted placing the New York State Association of Railway Surgeons on record as favoring the "Relief and Hospital Department." The following gentlemen were elected to honorary membership: Hon. Chauncey M. Depew, Hon. Cornelius Vanderbilt, Hon. J. M. Toucey; Rev. W. A. Dixon of Brooklyn; Dr. Roswell Park, Buffalo, and Dr. S. C. Graves, Grand Rapids, Mich.

Officers for 1897: President, Dr. J. F. Valentine, Richmond Hill, L. I.; first vice-president, Dr. Geo. Graves, Herkimer, N. Y.; second vice-president, Dr. F. H. Peck, Utica, N. Y.; Dr. C. B. Herrick, Troy, re-elected secretary, and Dr. T. D. Mills of Middletown re-elected treasurer.

Notes, News and Personals.

We are in receipt of a pamphlet descriptive of the Osgood palace car. If it proves to be a practical possibility it would seem to be simpler, cleaner, more easily ventilated and generally more comfortable than those now in use. We shall be glad to see a truly hygienic sleeper and gladly welcome all innovations looking in that direction.

Sir Benjamin Ward Richardson, M. D., F. R. S., etc., Honorary Physician to the Royal Literary Fund, the Newspaper Press Fund, and the National Society of Schoolmasters, died in London November 21.

He was born at Somerby in Leicestershire, England, on the 31st of October, 1828, and was educated at Burrow-on-the-Hill and Glasgow. He was graduated at St. Andrews University in 1854, and gained a number of prizes for papers on special medical subjects. In 1856 he was elected a member and in 1861 a fellow of the Royal College of Physicians, and soon after became a fellow of the Royal Society. In 1873 he was Croonian lecturer, and at different times thereafter was elected a member of various learned and medical societies on the continent of Europe.

In 1866 he discovered the use of ether spray for the local abolition of pain in surgical operations. He also introduced methylene bichloride as a general anæsthetic, and discovered the controlling influence of nitrite of amyl over tetanus and other spasmodic affections.

For some years he edited the Journal of Public Health and the Social Science Review, his contributions relating chiefly to the advancement of medical practice by the experimental method, the study of disease by synthesis, the restoration of life after various forms of apparent death, the maintenance of life in various atmospheres, the effects of electricity on animal life and various methods of killing animals without pain, which finally led to his invention of the lethal chamber now in general use. He also wrote many papers on new medicines and new modes of treatment of disease and on the effects of alcohol on man.

Dr. Richardson has been president of the Medical Society of London and of the St. Andrews Medical Graduates' Association for many years, and in 1868 received a testimonial, of a microscope by Ross and one thousand guineas, from his medical associates in recognition of his many valuable contributions to science and medicine. In 1875 at the Social Science Congress held in Brighton he read a paper in relation to a model city of health, which was the cause of prolonged public discussion. Of late years he has devoted himself largely to the study of the diseases common to modern civilization. His latest work was on "National Health."

Extracts and Abstracts. pears to have been fixation of the lower limbs,

Persistent Traumatic Dislocation of Both Hips.

Kofend (Wien. klin. Woch., August 20, 1896), records a case which appears to be unique in literature. The patient was admitted to Gussenbauer's clinic for malignant disease of the right lower jaw, which was operated on with success; the special interest of the case, however, refers to the condition of the lower limbs. Thirteen years before, the man being then 42 years old, was holding up a wagon with both hands; just as he was putting forth his utmost strength to prevent it toppling over he felt a crack in both hips, and was thrown backwards, the cart overturning beside him. He was picked up and carried home, where a bonesetter unsuccessfully endeavored to correct the displacement by pulling and over-extension, with the aid of four men. Cold applications were used, but no bandages; the patient was confined to bed for 14 weeks, then went on crutches for 8 months, and with a crutch and stick for 7 more. Since then he had been able to get about with the aid of a stick, and even to do light field work; he had never received any medical attention. When examined the right thigh was flexed, adducted and rotated in, the foot pointing forward. The region in front of the acetabulum was much flattened, but the head and trochanter could be easily felt bulging behind it. The trochanter was 4 inches above Nélaton's line, and the head lay in a capsule somewhat above and in front of the great sciatic foramen; the acetabulum was not palpable. Complete flexion was possible, the head slipping behind the situation of the acetabulum. Adduction was also perfect, but abduction was impossible, and the limb could not be straightened. The left thigh was bent almost at right angles on the body, the head being beneath the obdurator foramen, so that its movements could readily be felt per rectum. The limb was abducted and rotated out; it could be flexed and adducted, but extension was impossible and rotation limited. There was much creaking, and the acetabulum could not be felt; the dimensions of the pelvis were unaltered. There was also an old fracture of the left tibia, which had united with more than half an inch of shortening. The patient stood mainly on the right foot; the left sole could then only be brought to the ground by tilting the pelvis forward and to that side, so that the hip and knee were flexed, and the limb in the position of genu varum. To compensate this there was lordois and scoliosis, with the convexity to the left of the lumbar and lower dosal vertebræ. His gait was oscillatory, and walking only possible with the aid of a stick held in the right hand. The mechanism of the condition ap

the left in front, with over-extension of the body, causing the pelvis to slip off both femora. The patient refused an operation for the relief of the deformity. Kofend has collected 8 cases of acute traumatic dislocation of the hips, but has not been able to find an instance in which the condition had become permanent.— British Medical Journal.

Treatment of Rupture of the Kidney.

Keen (Annals of Surgery, August, 1896), in concluding an elaborate paper on the "Treatment of Traumatic Lesions of the Kidney," based on tables of 155 cases, discusses the indications for operative intervention in cases of subcutaneous rupture of this organ. Of 118 cases of this injury that have been published since 1878, 50 were fatal. On excluding 12 cases of associated injuries of other organs, 2 cases in which death occurred very soon after the injury, I case in which the patient possessed a single kidney, and an uncertain case, 34 cases are left, in 14 of which the fatal result was due to primary, continuous and secondary hemorrhage combined with shock, while suppuration, including peritonitis, destroyed 16. In 4 cases only was death caused by coma, anuria and nephritis. These figures support the view held by the author, that the dangers of rupture of the kidney are especially hemorrhage and sepsis. A more frequent resort to primary nephrectomy would, it is held, have avoided a number of deaths from both of those causes. The duty of the surgeon, it is pointed out, seems clear. Where the symptoms are threatening, particularly if there be decided evidence of hemorrhage, or probable danger of sepsis, an exploratory operation should be performed without delay. The great mass of recoveries in rupture of the kidney are the slighter cases; the graver cases do not recover unless an operation is done. In any case, therefore, with severe or dangerous symptoms the surgeon should lean toward exploration and in severe laceration toward early nephrectomy. Hæmaturia is regarded as being valuable only as a symptom showing the fact of rupture of the kidney, but not as a symptom by which to decide on operating. Not the visible loss of blood by the bladder, but the easily overlooked, but far more dangerous bleeding into the perinephric tissues, or into the peritoneal cavity, should receive the chief attention. If, then, a tumor form quickly in the lumbar region, an exploratory operation in the loin should be immediately made, and if the kidney be found. hopelessly destroyed, or the hemorrhage such as to require ligation of the renal vessels, nephrectomy should be practiced.-British Medical Journal.

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Notices and Reviews.

The Physicians' Visiting List, (Lindsay & Blakiston) for 1897. Philadelphia: P. Blakiston Son & Co.

This well-known visiting list comes to us this year with additional improvements, which will make it more acceptable than ever. The cover has been strengthened without increasing its bulk. The number of pages set apart for cash account has been increased besides other minor changes. As heretofore it can be had in five different styles. The regular form for 25 patients per week sells for $1.

An American Text-book of Applied Therapeutics for the Use of Practitioners and Students. Edited by J. C. Wilson, M. D., assisted by A. A.. Eshner, M. D. Philadelphia: W. B. Saunders, 1896. One volume, large 8vo, pp. 1,326.

This book contains 78 articles on the therapeutics of medical diseases, written by 42 different authors, and all American except two. The aim, seems to have been to create a strictly practical work of a high order devoted almost exclusively to the therapeutics of the different diseases as the writers respectively would teach or apply them, rather than to give a complete history of the therapeutics or any full account of the diseases themselves. The corps of contributors is an excellent one, the articles are in the main well studied and appear to be up to date, and the work is well edited. The book is well printed and a delight to read, although the volume is so large. No such work, the product of so many writers, can be perfect or even; this one is not. Some have written with refreshing fullness and detail, a few with regrettable brevity. Doubtless some things of importance have been omitted. The articles overlap in places, and perhaps some matters of minor significance are not treated. But the work contains more accurate, practical wisdom of the hour on the subject than any single author could hope to have put together and is altogether a book of superior excellence. A few of the writers may have forgotten that the basis of pathology has changed of late, but in the main the treatments recommended are based on the modern doctrines of the causation and nature of disease, and this is one of the chief charms and greatest merits of the work. We have been moving forward in the study of etiology and pathology and lagging behind in therapeutics. To-day no man can write a true account of human disease except in full view of all the meaning and possibilities of infection and the intoxications. This may not be the correct basis, but it is the best we have so far attained, and our treatment of the sick ought to be in accordance with it. If future discovery shall give us a better basis we ought to be frank to change our therapeutic methods, and one of the best things a truly mod

ern doctor can do for himself and his patients is, every half decade of his career, to overhaul his knowledge of therapeutics and his habits of procedure and bring them up to date if he can. Such works as the one under consideration are invaluable aids to this process and they are greatly to be commended.

N. B.


"A New Dressing for Fracture of the Clavicle," by M. L. Harris, M. D. Reprinted from the Chicago Medical Recorder, September, 1896.

"Chorea," by Henry Hatch, M. D. Reprinted from The Journal of the American Medical Association, October 17, 1896.

"The Diagnosis of Tuberculosis from the Morphology of the Blood-An Original Research, with Report of Cases," by A. M. Holmes, A. M., M. D. Reprint from the Medical Record, September 5, 1896.

"Gonorrhea in the Puerperium," by Albert H. Burr, M. D. Reprinted from The Journal of the American Medical Association, August I, 1896.

"Infantile Scorbutus," by Albert H. Burr, Ph. B., M. D. Reprinted from The Journal of the American Medical Association, November 7, 1896.

"Optic Neuritis," by William H. Wilder, M. D. Reprinted from International Clinics, Vol. II, Sixth Series.

"Chloroform in Labor," by Frank B. Earle, M. D. Reprinted from the Chicago Clinical Review, April, 1896.

"The Use of Cicatricial Skin Flaps in the Operation for Ectropion of the Upper Lid," by F. C. Hotz, M. D. Reprinted from The Journal of the American Medical Association, September 19, 1896.

"On the Importance of Physical Signs Other than Murmur in the Diagnosis of Valvular Diseases of the Heart," by James B. Herrick, M. D. Reprinted from Medicine, October, 1896.

"Report of a Case of Typhoid Fever Complicated by Extrauterine Pregnancy," by James B. Herrick, M. D. Reprinted from the Medical News, October 17, 1896.

"Thyreoid Therapy," by James B. Herrick, M. D. Reprinted from Medicine, August, 1896.

"Hypnotic Suggestion as a Cure for Asthma," by Thos. Bassett Keyes, M. D. Reprinted from the Medical World, July, 1896.

"The Treatment of Dipsomania, Morphiamania and Onanism by Hypnotism," by Thos. B. Keyes, M. D. Reprinted from The Journal of Materia Medica, April, 1896.

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