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The Alvarenga Prize of the College of Physicians of Philadelphia.

The college announces that the next award of the Alvarenga prize, being the income for one year of the bequest of the late Señor Alvarenga, and amounting to about a hundred and eighty dollars, will be made on July 14, 1897, provided that an essay deemed by the committee of award to be worthy of the prize shall have been offered. Essays intended for competition may be upon any subject in medicine, but cannot have been published, and must be received by the secretary of the college on or before May 1, 1897. Each essay must be sent without signature, but must be plainly marked with a motto and be accompanied by a sealed envelope, having on its outside the motto of the paper and within the name and address of the author. It is a condition of competition that the successful essay or a copy of it shall remain in possession of the college; other essays will be returned upon application within three months after the award. The Alvarenga prize for 1896 was not awarded.

Massage and Movements in the Treatment of Fractures.

Dr. G. G. Davis of Philadelphia concludes a very interesting paper on the above subject as follows:

(1) It is my belief that massage and passive

motion is not used to the extent that it should be in the treatment of fractures.

(2) That immobility of the fractured ends favors quick union with little deformity.

(3) That there are some cases in which, owing either to peculiarities of the fracture or the impaired constitution of the individual, the tendency to the formation of callus is marked. Motion in these tends to the formation of exuberant callus and deformity.

(4) There are others in which bony union is unduly delayed; disturbance of the frac

tured ends in these hinders union.

(5) It is wise to wait until the fractured parts are glued together, usually eight or ten days, before attempting any except the lightest massage, and any extensive passive motion after that time should be used carefully but diligently.

(6) Passive motion and massage when first attempted should be of the most gentle character, and not so violent as to disturb the relation of the broken bones.

(7) Any marked pain and inflammatory reaction following passive motion and massage is evidence that it has been too violent.

(8) The limb should receive massage and

manipulation at each inspection or change of dressing, often daily.

(9) That in some cases it is advisable to administer such massage as is possible without removing the splints.

(10) That persistent stiffness, particularly in fractures or injuries of the wrist, is often due to rheumatoid affection locating itself in the injured region. Massage is valuable in the treatment of such.*

(11) Massage should be given to that part of a limb beyond the seat of fracture to preserve it in a normal condition.

(12) Such dressings and methods of treatment should be adopted as will allow of the greatest use of massage and passive and active movements consistent with proper retention of the fragments.-Annals of Surgery.

The Railway Hospital.

The following is an extract from a paper read before the New York State Association of Railway Surgeons, by Dr. Frank H. Caldwell:

A letter addressed to Mr. B. R. Swoope, Superintendent of the South Florida Railroad, and chairman of the hospital executive committee, requesting his views as to the necessity for, and the benefits of, a railway hospital, was answered in the following brief and concise


"First, a properly organized hospital service is essential, in my opinion, to every railroad of any size, from the fact that it is almost impossible, if not quite so, to secure the necessary medical and surgical attention in case of personal injury to either passenger or employe through any other channel. Further, employes can receive medical treatment in a hospital with competent nursing and proper food, by which they are restored to health quicker than if treated elsewhere, and the company receives the benefit of having its men in their accustomed places, instead of having them. filled by less competent persons.

"Second, the benefits to be derived from a hospital service are wholly mutual to employer and employe; the two are bound close together, and fully realize that their interests are common to a great extent, and each individual who contributes toward the maintenance of such an institution, feels that a certain part of the responsibility connected therewith is upon him, insuring greater success than could otherwise be attained. The employes receive whatever medical or surgical treatment may be required at less expense to themselves than could be had elsewhere, and in cases where employes have no families, a home is provided for their care and comfort while sick; in cases of per

The use of the local hot-air bath promises to be as valuable in limbering of stiff and contracted extremities as is massage.

sonal injury the railroad has saved hundreds of dollars annually in settlement of claims, as well as in the payment of surgeons' fees which it would be compelled to assume, it being a well-known fact that the ordinary jury will decide a case in favor of the 'poor' individual injured, and against the wealthy, soullesss corporation, without regard as to whether the evidence exonerates the latter of all blame or not."-International Journal of Surgery.

Concerning Vacations.

Dr. E. H. Judkins writes as follows in the Journal of Medicine and Science:

Life is a conflict, a battle, in which the "survival of the fittest," as well as the success and longevity of the un-fittest, is sometimes peculiarly exemplified. In the struggle for existence, few of us can hope to escape toil and trouble. To labor is the common lot; genius itself is but a special aptitude for labor, steady, persistent, patient toil.

Some successful people, like poets, are "born not made;" but in this aggressive age and country, most of use are "self-made or never made." We are told-and most of noted persons named in the Biographical Dictionary, have experienced-that:

"The heights by great men reached and kept,
Were not attained by sudden flight;

For they while their companions slept,

Were toiling upward in the night."

It is the sweaty brow that wears the laurel crown. "Nothing succeeds like success;" but labor and sweat are essential to its realization. Success requires, as Carlyle said, "Sweat of the brow, and up from that to sweat of the brain; sweat of the heart, up to that agony of bloody sweat, which all men have called divine!"

Indeed, all men of genius and renown show that they had to "learn to labor, and to wait"— but not to wait for "something to turn up." They soon learned that to obtain any sure success in this world, they must be "up and doing." One must

"Seize this very minute.

What you can do, or dream you can, begin it; Boldness has genius, power and magic in it, Only engage and then the mind grows heated; Begin, and then the work will be completed." But, the efforts and energies that which half a century ago would have resulted in fame and fortune, now hardly suffice to place one upon the ordinary level. The country is so rapidly populating and competition becoming so intense and active, one has to "strain every nerve" to win in the race. To-day, we have intelligence, knowledge and education well-nigh universal; they are the common lot and heritage. As Professor Agassiz said, "the time. has come when knowledge and truth must cease to be the property of the few-when they must be woven into the common life of the

world." Civilization moves rapidly forward, with mighty strides, bearing its grand motto, "Onward, Improvement, Progress."

"And I doubt not through the ages one increasing purpose runs,

And the thoughts of men are widened with the process of the suns."

But amid the hurry and bustle of our American life, particularly in the cities, we find men. "breaking down," their mental engines are overworked at high pressure. They strive too actively and worriedly to "keep up with or excel their perhaps better qualified brothers in the race."

"In the strife of brain and pen,

'Mid the rumble of the presses, Where they measure men with men."

This is the crucial test; and here comes in play the vacation season to relieve the strain, recruit the system and prepare anew for the conflict. Vacations are the safetly-valves of our modern civilization. our modern civilization. Recreation is recreation. The over-taxed brain, the body tired and weary with the ceaseless routine of multiform duties, needs rest, relaxation. Hence, it has become a fashion, as well as a necessity, for people, particularly denizens of the city, to fly to the river, lake and sea, the mountains, woods and vale, for rest and quietude; and there obtain good, solid comfort amid the rural scenery, the quiet nooks and shadowy dells of primeval nature. How "many a time and oft" the tired merchants, weary accountants or clerks, the busy lawyer, physician or clergyman-as well as the toiling workman-cooped up perhaps in some heated city; how often they long for the country! One may be "all alone with ten thousand around him," still he sighs for the "sweet seclusion" of nature's own solitudes. He knows that in the sylvan shades and the white sunlight of the rural regions he will receive renewed health and energies for the earnest duties of life. If Sancho Panza invoked

blessings upon the man who invented sleep, we should also praise the one who instituted vacations.

It is not good for man to remain forever in the same place, and thus he differs from a tree, which flourishes the more luxuriantly the more solidly it is rooted. With a human being, all physicians agree that a change of scene is the best medicine to prescribe for a tired or "routine tortured" person. And right here it is suggested that all doctors should manage to get a respite from the usual rounds. They owe it to themselves, as well as to their patients, to take rest from dispensing powders and potions, and see what "the rest of the world" is doing. Go to the mountains, lakes or sea; take a trip to Europe, or visit hospitals in the great American medical centers. Refresh the mind with new ideas, re-seed the fallow ground and rest the old notions for a season.

The writer once knew of a physician, so he

thought himself, whose boast was that he had practiced twenty-five years without a day's vacation; at the end of which time he was so rusty and in one rut, that he knew of but a single disease with him-the liver stood sponsor for every disorder of which people complained; but this disguise of the ignorance of the doctor did not always satisfy even the ignorance of the patients, and when one of the attacks of biliousness was diagnosed as appendicitis, by a young physician who proved it such by a post-mortem upon which he insisted, the "old doctor's" spell was broken.

Circumstances afterward compelled him to visit near-by hospitals, where he saw and heard of some modern inventions as well as latterday medical and surgical practice. Hence, we should try to rub off the rust while we rest and to take occasional vacations where we can encounter new ideas, then when anything is learned put it in practice and report results to the medical journals. While we take our play day, and get no end of new ideas, let us remember that the Journal, like the brook, "goes on forever"—so we hope-and it must get its summer vacation, second-handed, from us. Then let us write up what strikes up with vividness and force, even though out of proportion to its true value. Ideas are always acceptable, whether from practice or from play-as a "looker-on in Vienna."

Semi-Centennial of the American Medical Association.

In view of the fact that the next meeting, which is to be held in Philadelphia, June 1-4, 1897, will be the semi-centennial gathering, and that it will occur in a great medical center, and near the other great cities of the Eastern coast, the Committee of Arrangements for this meeting have already made provision for the accommodation and entertainment of the delegates by the engagement of the Academy of Music, Horticultural Hall, the South Broad Street Theater, and the large meeting rooms in the Hotel Walton and Hotel Stenton. As these large buildings are all within a short distance of the great railroad depots in the center of the city and are all situated within one block on both sides of Broad street, every department of the meeting will be conveniently arranged. At the last meeting of the association it was voted to devote the first evening of the meeting, Tuesday, June 1, to dinners of the various sections. The officers of the sections desiring to give such a dinner will please communicate with Dr. G. E. de Schweinitz, Chairman of the Sub-committee on Accommodation, 1401 Locust street, as early as possible in order that dining-rooms may be engaged or other entertainment provided. As it is expected that fully three thousand physicians will

be present, the committee suggests that applications for accommodations be made as early as possible. It is hoped that every member of the association will make a special effort to attend. Further circulars of information will be issued by the committee from time to time. Individuals and firms desiring space for exhibition in the Exhibition Hall, which will be in the same block as the various meeting halls, will please apply promptly to the Chairman of the Sub-committee on Exhibits, Dr. Edward Jackson, 1633 Locust street, Philadelphia.

The Semi-Centennial of the Discovery of Anesthesia.

The London Practitioner for October, 1896, is devoted to the celebration of the jubilee of anææsthesia. Dr. Frederick W. Hewitt, anæsthetist to the London Hospital, has an article on "The Past, Present and Future of Anæsthesia." Dr. Hewitt, it will be remembered, is the brilliant author of a most excellent work on the subject of anææsthesia. Public spirit in England, which has much to do in general with retarding the advance of the medical profession by interfering with free experimentation upon the lower animals and by condemning in an ultra-conservative English way new procedures in surgery, has advanced, on the contrary, the art of anesthesia; and this, for the reason that deaths from anesthetics alone cause profound disturbance of the public mind. and the consequent reaction against the surgeon in charge is very great. The result has been that special anesthetists have been appointed to all the important hospitals, and anesthesia is not institued without very grave consideration and the most elaborate precautions to prevent accident. Dr. Hewitt is one of the best exponents of the art. He does not look forward to very great advances in anæsthesia in the future, as from the very nature of the case it must be difficult or impossible to find an anesthetic which will be free from dangerous qualities. We may, however, hope for better combinations of the anesthetics we already have, and possibly better methods of administration.

Mr. Geo. Rowell has an article on the Work of Simpson, Snow, Lister and the Hyderabad Chloroform Commission. He summarizes our present knowledge as follows: Chloroform is a dangerous drug, because of its deleterious effect upon the heart. If air limitation be carefully avoided and the patient's various symptoms carefully watched, an overdose should never occur. This being avoided, the risks during chloroform administration are mainly associated with imperfect degrees of anæsthesia, and the great risk lies in the occurrence of asphyxia, however produced. Although with experience and care the number

of chloroform deaths is capable of considerable reduction, yet chloroform is not, in spite of its advantages, the most desirable drug for routine use in producing anesthesia; still it is of great value in cases in which, from some diseased condition of the patient or from the particular requirements of the surgeon, ether and mixtures are contra-indicated; and this, beyond doubt, is its true sphere of usefulness.

Mr. F. Woodhouse Braine, in an article on the Administration of Ether, recommends that nitrous oxide be given to the point of producing insensibility, and that then the Ormsby inhaler, in which has been poured about two ounces of ether, be applied; a single inspiration of air in the interval should not be allowed. This is a favorite method of administering ether in England, and seems to have many points in its favor, although the immediate effect of the nitrous oxide upon the patient is certainly not pleasant to look upon.

Mr. George H. Bailey writes on the Principles of Ether Adiminstration. Dr. Dudley W. Buxton tells the story of the Discovery of Anæsthesia, and Mr. Frederick Treves writes a short and valuable article on the Use of Anæsthetics in Operative Surgery. To make the picture complete, Dr. Alfred Hartley contributes an article on Anæsthetics from the General Practitioner's Point of View. Instruction in the art of administering anæsthetics is insisted upon by Mr. Marmaduke Shield. Mr. J. Milne Bramwell writes on Hypnotic Anæsthesia. Editorial articles on the pioneers of anesthesia, Wm. Thomas Green Morton, the discover of ether anæsthesia, and Sir James Young Simpson, who first used chloroform as an anæsthetic, are adorned by excellent portraits of these two great men.-Medicine.

On Fractures of the Femur Caused by Twisting.

In the Berliner Klin. Wochenschrift, August 31, 1896, Tillmann reports five cases of fracture of the femur, caused by twisting the thigh. The violence seemed to him insufficient, and led him to an investigation of the subject, with most interesting results. In four cases the thigh was broken in the attempt to remove the boot, and in the remaining case the movement was the same, as the thigh was broken while the patient a young man was examining a wound in the sole of his foot. Three of the patients were men, aged nineteen, thirty-seven and forty-eight; and two were women, twentyseven and thirty-six years old. The man of forty-eight years died as a result of his injury. He had suffered for ten years from tabes-dorsalis, while the woman of thirty-six years had shown the symptoms of this disease for two years. It is reasonable to suppose that the femur was weakened in these two patients by

this disease, a possibility pointed out by Weir Mitchell in 1873. Charcot says that four per cent. of tabes-dorsalis patients present trophic disturbance of the bones. The other three patients were carefully examined, but they gave no symptoms either of tabes-dorsalis or of any other disease which would account for a reduced strength of the femur. Messerer has shown that although a femur requires from 700 to 1,000 pounds' pressure to cause it to break by bending, its shaft will give way under a twisting force of from eighty to 300 pounds, a force which is far too small to break off the head of the bone or to tear apart the ligaments at the knee or hip. Tillman attempted to verify these statements upon the cadaver, but he was able to break the femur by twisting in only seven instances. Two of these occurred in children of six and eight years of age, and the others were all in cadavers over sixty years of age. In the other subjects, owing to decomposition, the ligaments at hip and knee gave way. Dissatisfied, therefore, with the results, he looked up the three patients in whom fracture of the femur had no explanation, and at intervals since the accident of eight, five and three and one-half years respectively, he found every one presenting well-marked symptoms of tabes-dorsalis.-Medical News.

Use of Large Non-Pediculated Flaps for Plastic Purposes.

Krause of Altona reviews this subject at length in Volkmann's Sammlung Klinischer Vortrage, No. 143. The following abstract is from the Annals of Surgery: The fact that flaps of skin entirely separated from their surrounding tissues would heal, if transplanted, has been known for more than a century. Skinflaps taken from the thighs were used to make artificial noses in India during the latter part of the last century. Although these operations were performed by craftsmen they were more successful than the surgeons. The latter did not succeed in their efforts to utilize non-pediculated flaps until the middle of the present century, when Wolfe was successful in transplanting a flap to form an eyelid after having removed the subcutaneous fat. After the introduction and general adoption of the Thiersch method, this one was abandoned. Krause was the first surgeon to attempt to use flaps of skin extending down to the adipose layer successfully. He at first, following the method of the Indian craftsmen, whipped the flap after having detached it upon three sides in order to produce an artificial hyperæmia, but since then has not done so, since this procedure seems harmful. The secret of success is most strict asepsis and the use of no antiseptic solutions or moist sponges, in fact a perfectly dry operation. He prepares a granulat

ing surface to which the transplantion is to be made by baths, curettement and wet aluminum acetate or creoline dressings, all cicatricial and chronically inflamed tissues being removed. Hemorrhage is checked by gauze sponges. The part of the body from which the flaps are taken must be thoroughly cleansed, all antiseptic solutions being washed off with sterilized water. The flaps are cut off in the form of a longitudinal ellipse and are then shaped to the part to be covered. They are cut off with a scalpel between the cutis and subcutaneous fat. After dissecting up the tip, this is folded in so that the wound surface of the flap is covered as more and more of it is dissected up. If a very small amount of adipose tissue remains it will not interfere with the nourishment of the flap. The latter usually shrinks to two-thirds its original size longitudinally and a little less transversely. It adheres to the prepared surface as if glued on. Secondary hemorrhage is most likely to occur when a flap is placed upon the cancellous portion of bone. It is better to wait a few days before transplanting upon such tissue, because nutrition of the flap through newly-formed blood vessels does not occur until the sixth day, before this it is nourished by diffusion from the vessels, and this will be impossible if a blood-clot intervenes. Krause never transplants upon freshly-severed tendons or upon cartilage on account of the lack of sufficient nourishment for the flap. In transplanting upon the leg or arm it is not necessary to suture the flap. The dressing must, however, be most carefully applied. The limb should be massaged daily after transplanting ulcers of the leg. In nineteen cases of such ulcers which he transplanted fifteen were successful after a lapse of three and a half years. He used this method in forty-seven cases, in the majority of which he was successful. The special indications for this method are when extensive defects are to be covered upon the leg or arm, especially when the cicatrix is exposed to mechanical injury. The frequent ulceration of Thiersch's grafts under these circumstances renders these unfit for such surfaces. The conditions for a successful operation are strict asepsis, dry operation and thorough preparation of the area to be covered.

Calomel Hypodermically.

The calomel is blended with sterilized oil and every precaution observed to prevent infection with the needle. A long, strong needle is used and the fluid is injected deeply into the tissues of the right loin. No suppuration or nodosities follow. The maximum dose of calomel by this plan is five centigrams, about one grain. By this method the patient is spared the pain and inconvenience of stomatitis, and, besides, the action of the drug is more energetic and decisive.-Therapeutic Review.

Notices and Reviews.

The Uses of Suffering. By G. W. H. Kemper, M. D New York: Eaton & Mains, 1896.

This pamphlet, as explained by the author in his preface, "Is a plea for the goodness. of God as manifested in disease and suffering." It points out the fact that we are all made better and stronger by suffering and shows the utility of disease and the necessity for death. The little book will no doubt bring comfort to many a sad heart and give new courage to many a faint one. It is written good paper. in a simple, easy style and is well printed on

Minor Surgery and Bandaging. By Henry R. Wharton, M. D., demonstrator of surgery in the University of Pennsylvania. New (3d) edition. In one 12mo volume of 594 pages, with 475 engravings, many being photographic. Cloth, $3.00. Philadelphia: Lea Brothers & Co., 1896.

This book forms one of Lea Bros.' Red Book Series of practical manuals, and we desire to commend its use for students in their practical work in bandaging and operative surgery. The various procedures are tersely and intelligently described, and splendidly illustrated. About the only criticism we have to offer is that the contents of the book have outgrown the title, and in the author's efforts to retain a small sized book he has inadequately described some of the important points of the treatment of fractures and dislocations, and omitted valuable details in his descriptions of operations.

In the treatment of dislocations of the shoulder and hip considerable space is given to old and barbaric methods of reduction, while the valuable principles, as formulated by Biglow and Gunn have been entirely omitted. The manipulations described would, in the reviewer's opinion, fail more frequently than succeed on the live subject. While there are several omissions in the details of amputations like the removal of the head of the metatarsal bone in amputation of the great toe, etc., the most vital one is that of neurectomy in amputations. Nothing is more important than primary neurectomy in amputations.

This book is more properly a manual of bandaging and operative surgery, and in studying it the student should always keep in mind that it is but a manual. As such we feel warranted in commending it most highly. It is printed in large, clear type, on good paper and in such a convenient size as to make its use handy during practical work in the laboratory. A. I. B.

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