Railway Surgeon

PUBLISHED EVERY OTHER TUESDAY BY

thing to a very good joke is a very bad one, but this one carries out Milton's definition of the sublime that which is palpably obscure:

"Bacteriology is a great science, and during the past twenty years has developed with

MONADNOCK BLOCK, CHICAGO, ILL.

THAT MICROBE OF OLD AGE.

Microscopic lies are not always little lies. They are the gilded fiction of bacteriology coming from a universe of infinity of unimagined minuteness and an incomprehensible multiplicity of living factors. A microbe is like man. He is a connecting link between a material universe and an unknown infinity of life's immateriality.

The lunatic and the microscopist are expected to have an unlimited imagination. One see worlds through his mind's eye, while the other searches with imperfect aids for the boundary of an infinite space; there are worlds and worlds which dazzle the field of the microscope and are as unknown as are heavenly planets.

We have heard what the man thinks of the microbe, but the illumined field of the slide will not tell us what the microbe thinks of the man. We are inclined to believe that if man continues to make microbes possessing the idiotic function of what here follows, the microbe's opinion would be justly and germfully severe. Here is a part of an editorial upon the microbe of old age taken from a daily paper. It has been said that the next

seems to be a tendency on the part of the investigators to construct a 'microbe theory." In this they have been so successful that theory is now far outstripping our actual knowledge of cause and effect as applied to these socalled 'germs.'

"One school of European bacteriologists are willing to stake the reputation of every student of the science from Bastian and Pasteur down to Johnson of Kansas that bald-headedness in the human species is caused by the ravages of a microbe which they have called the bacillus carnivorax.' Its discoverer, a Frenchman by the name of Saymonne, also professes to believe that drunkenness is contagious, and that the 'microbe of alcoholism' will eventually be discovered. The microbe of insanity is even more than suspected of being an undiscovered reality.' The air surrounding angry mobs of men is also said to be filled with microbes that will, upon being inhaled, almost instantly convert an onlooker and make him believe that the object of the crowd's wrath should be exterminated.

"In short, there is no end to the fancies which imaginative microbe theorists can conjure up.

"Ridiculous as the majority of these theories national reputation who can expound such are, there are dozens of investigators of interdoctrine by the hour and bring excellent arguments in proof of what they say along their special lines."

Here is potted wisdom. Ignorance is the wet nurse to this germ theory. Here is progress; these are living moments, but it is an awful scale in progress between that baldheaded bacillus called the "bacillus carnivorax" and man. Ponder on that contagious bacillus which produces drunkenness called the "microbe of alcoholism!" We thought that it was a barkeeper, not a microbe. Again, that “undiscovered reality," the "microbe of insanity." Then it is not oppression which makes wise men mad but microbes. Last but not least, that hoodlum microbe causing mobs to act with effect on all men concerned.

Thank heaven the force, influence and the active consideration of self and other matters will debar these new germ theorists from discovering the microbe of a real actively engaged cyclone or a busy earthquake. The bacteriologist who tries to discover the mi

crobe of a bursting steam boiler will blessedly and fatefully leave his researches incomplete. We trust that close contact will be necessary for the discoverer of the microbe of exploding dynamite. Telescopes in this case would be. efficient in discovering his remains.

THE EXTREMES OF SHOCK AS MANIFESTED IN RAILWAY INJURY.

A RETROSPECTION.

Nordau says: "Egotism is a lack of amiability, a defect in education; perhaps a fault of character, a proof of insufficiently developed morality, but is not a disease. The egotist is quite able to look after himself in life and hold his place in society; he is often, also, when the attainment of low ends only is in view, more capable than the superior and nobler man, who has inured himself to selfabnegation. The ego maniac, on the contrary, is an invalid, who does not see things as they are, does not understand the world, and cannot take up the right attitude toward it."

We have always viewed retrospection as a more or less harmless by-play of egotistical thought, with just enough of the "I" in it to give it individuality; besides, there should be permitted in the rehearsing of past experience a liberty of style not generally permitted in scientific communication. Basford may be correct, when he says: "One who uses many periods is a philosopher; many interrogations, a student; many exclamations, a fanatic." Again retrospection, to make it truly interesting, should be more or less altruistic; the "I" or ego should add to the true condition of others. The story of the suffering of man should always aim to interpret the virtues and defects of others, and while the writer may extol the virtues of others, he unconsciously shows his character in the detail. For Froude says: "The essence of true nobility is a neglect of self. Let the thought of self pass in and the beauty of great action is gone like the bloom from a soiled flower.'

Experience, after all, is but "retrospect knowledge," and gives us the truest ideas of life and man and more completely adds to the knowledge and wisdom of others than to ourselves.

Reviewing life, as a doctor, for the past thirty

And he alone is blest who ne'er was born."

Man's life at best is uncertain and particularly so the vocation of a railway employe. It is very brief at the longest and very troublesome in its most favored conditions. But particularly so with the employe, who is surrounded by ponderous moving power; by the by-play of uncertain footing and the paralyzing, forceful action of gravity. All of nature's forces are at times arrayed against him; darkness, fire, storm and deceitful surroundings; morbid mental conditions, the criminality of bad men, the abberrations of time, nature, place, and the uninterpretable actions of Providence. Hence, more keenly than many in other vocations, we naturally view life as the most uncertain of all things, and simply for the reason that in a long and active career we have seen death come so suddenly, so rapidly, so unexpectedly, and in such appallingly shocking forms as to debar the possibility of the exercise of anything like normal and unruffled thought and explanation. Within a few minutes we have seen men, full of bouyancy, hope and strength, changed into a mangled mass of inanimate, discolored bone and flesh, an absolutely appalling change from a condition of force, power and effect to a gross materiality. The railway hospital surgeon is under a constant tension; every element of humanity and feeling, every element which makes him turn to inner consciousness is almost continuously rife. To anyone having experience in the severer forms of railway accident, shock, profound shock, or, as it has been called by some, “traumatic delirium," that benumbing, unknown quantity is very familiar. For constantly, the most tragic and soul harrowing element of his life is depicted in the results of shock.

We believe that the derivation of delirium,

a

curious as it is, comes from de, which means from, and lira, which means ridge between two furrows; a quaint, but suggestive derivation. These two furrows to us represent life and death and the ridge the mutilated man between, and certain it is that the separation between these metaphorical furrows is only too oft marked not only by hours, but by

minutes and seconds as well.

The history of railway accidents shows that they rarely come with a mild and placid aspect, there is eternally an element of shock to all concerned, which is constantly produced in consequence of the immense difference between the effect, intensity and result. While some competent authority has seen fit to describe the condition, as "traumatic delirium." We understand delirium to mean, “a state in which one's ideas are wild and irregular and unconnected -mental abberration-strong excitement, wild enthusiasm, insanity, frenzy, madness." Excitement there may be in these cases, but there is in the most pronounced cases, no mental abberration, and hence we would rather use the expression shock than to characterize this condition as one of delirium.

We desire to say that in spite of the caption of "traumatic delirium," the words of Dr. William Hunt, senior surgeon, to the Pennsylvania hospital, Philadelphia, contained in a contribution to Ashhursts' International Encyclopædia of Surgery, have given a most classical description of this condition, and we take pleasure in quoting from him. He says:

"There is a rather rare form of immediate traumatic delirium, which, nevertheless, must be more or less familiar to every surgeon of a great accident hospital, or to those who are in any position, as upon the battle field, where they become familiar with sudden and severe casualities. Delirium might appear to some to be a misnomer, for the characteristic is that every word and idea are perfectly coherent. There is great exaltation of mind, but an utter want of appreciation about the injuries. Trauma of the spine has been involved in the crush and the line of communication of the brain has been cut off, but this is not necessarily the case. There is no collapse at first; the skin has its normal temperature, the pulse is full and rather frequent, the face may be more flushed than natural, the eyes bright and the expression good. The surgeon enters a ward some morning after a terrible accident has occurred, and finds that a victim of this kind has just been brought in and laid upon a bed.

He is at once recognized by the patient as one in authority. 'How are you, Doctor,' he says in a high voice, 'what have they brought me here for. I am not hurt! No sir, look at that!' And out goes an arm with the force of a prize-fighter, delivering a crusher. 'Look here! And he tries to lift a leg, which his sensorium falsely tells him he has done, al

though his expression may indicate a vague and passing doubt. 'Why, there is my wife! Molly, what are you doing here? Don't cry, what are you crying for? I'm not hurt, go home to the children and tell them I'll be there to supper, and at the mills to-morrow! Won't I, Doctor? Go home!' Soon this great tension gives way, collapse comes on and by night the patient is in another home than that in which he promised to be. I have never known such a case to recover. With all its coherence, with every intellectual and perceptive process correct, as far as external matters are concerned, every word and thought as to other persons and objects right, everything as to himself wrong, how are we to classify this state, except as one of delirium? Important questions might arise as to the testamentary capacity of such persons; from what I have seen and described there is nothing in their condition inconsistent with full ability to direct the management of their estate and effects."

Yes, we fully agree that every element of perfect mentality is present. For many years we have seen this, and can bear testimony to the fullest detail of the truthfulness of this description as far as it goes. Let us carry out the description a little further. After the crushed and mangled patient lies there a while, and still viewing everything with a quick and alert eye, he suddenly says: "Give me a drink, raise me up, give me a little air! Oh! but that water was good, give me another drink!" As we notice him we find that his face is becoming blanched, his pulse quick and weaker, big drops of perspiration hang upon his brow; the alæ of his nose begin to move and vibrate with every breath. His face now turns more brilliantly pale, almost phosphorescent. His voice has now a slight husky tone, he suddenly and without any seeming effort spews

out of his mouth the clean, uncolored water he has just taken, and with each attack of emesis his pulse becomes more feeble and intermittent. "Give me more water," he calls, "that's good, thank you." Memory is now slightly touched. "Did you give me that drink? Please give me another." Again emesis stops his utterance. "Oh, for God's sake turn me on my side, my back is killing me, give me some

more water, quick!" Again emesis occurs. "My God, I will die unless I can turn over, lift that leg, oh, that does not do any good, give me some more water! Oh, my God, how that leg hurts, raise me up, more water please!" And then emesis again. And now suddenly an almost instantaneous change comes over him, his bright and brilliant eye, profoundly intense in expression, seems dull and the alæ of the nose move with rapidity, when a sudden spasm seizes the injured man. He slowly turns his head, with tense and rigid muscles, to one side, his breathing becomes shallow and rapid, and the pulse has stopped. With a long, deep gasping breath, death has ended his life, his face partially buried in the pillow.

Delirium, or no delirium, we certainly believe that a great majority of these cases, under the influence of profound shock or call it, if you will, traumatic delirium, have the full, free and unruffled use of good sense, and are competent to decide any question influencing their material interests or regarding the disposition of their material effects. We have truly an exaltation of mentality, but the brain still lives, seemingly superior and paramount to the physical condition, and acts with lightning-like celerity, glowing with an intense excitement. Again, we not infrequently find in grave and severe injuries that a plainly manifest condition of delirium does exist, verging upon insanity. In one case where a truely religious catholic was hurt, immediately following his injury, a wild traumatic delirium made itself manifest. He acted entirely different from what his nature and habits would have indicated. He not only cursed doctors and attendants, and used the most foul and profane language, but cursed and damned the priest who sought to give him consolation. Again, we have seen them under the influence of shock in almost a maudlin condition. A man who had both of his thighs crushed was full of laugh and inanity; he leeringly, foolishly and idiotically laughed at the doctors and when the priest came he said to him: “I'm a railroad man, won't you forgive me?" This was the only sentence he would utter. He would laugh and wildly turn his eyes and repeated as long as he could see the priest, the words just quoted. Again, in one case we have seen almost complete and perfect placidity of mind, no excitement, no unusual appearance of the countenance, and had a sheet

been so placed as to cover him from his neck down, one surely would have thought that the patient was simply comfortably resting and not a fatally injured and dying man. Both of the man's lower limbs had been crushed, nearly up to the pelvis. When we came to his side he said with the utmost coolness and in an unruffled voice: "Doctor, what do you think? Will I get well or not?" We were compelled to say that we thought he would die, shortly after which he turned his head and coolly viewed the attendants and said: "I asked this question of the doctor, because I knew that he would not lie to a dying man; now I know that I am bound to die." And he did not survive fifteen minutes after the announcement was made to him. From our earliest experience in treating railway men, with grave and fatal injuries, we formulated this opinion: That in spite of traumatic delirium or intense shock, almost every man (unless his brain be injured), who dies under these conditions, shows a pronounced individuality, constantly present, the peculiarities of the individual ever manifest. There is no classical description which will hold in all cases of either so-called traumatic delirium or profound shock. The brave man, the sensible man is manifest as such in shock; the coward, the fool and the villain almost always indicate the peculiarities of their mental condition (with an uninjured brain), according to the predominating characteristics of mind. We have seen all the philosophy manifest that man is capable of manifesting, and that where we would never have suspected its existence. We have seen the dread and terror manifested among the culpable and guilty, the placid death of the believing Christian, and the uncertain mental elements of the superstitious. Death to the surgeon upon the railway always presents the predominant characteristics of the individual, just as in life, with the exception of a higher moral tone which is almost invariably manifest in the presence of death.

An Englishman, who had been noted for his cool, calm, clear judgment and non-combative disposition, even under the influences of stimulants, was caught between the draw-heads of passenger cars, prior to the introduction of the Miller platform and coupler; after the accident he spat up a mouthful or two of scarlet arterial blood, and was conveyed to his home in a dying condition. Everything indicated the near

approach of death and his wife was so informed. She implored us to announce the fact to the dying man and to ask him whether or not he did not desire the presence of a priest or minister. So accordingly, we approached the patient and detailed the message as requested by his wife. He turned slowly and looked up, and after a moment or two of thought said: "Doc, tell the Missus to come in here." She was summoned and he then said: "Missus, have I not always followed out my religion?" "Why, yes, you have," she said, "but in your own peculiar way of believing. Why, Doctor, he believes in the Golden Rule, that is to do unto others as you would have them do unto you. He has invited into this very house mean, low and dirty dogs, who have shamefully wronged him, as though these men were good as angels, simply to return good for evil." "Ah, there, Missus," said the dying man, "that is neither here nor there, I have clearly done my duty. Now, Doc, I would like to ask you this question: If you had a business transaction and you could settle it with yourself and the other party better than in any other way, would you call in a third party? Well then, Doc, and you, too, Missus, what is the use of my calling in either priest of preacher when God Almighty and I can arrange our differences better than anybody else?" And with this opinion he died.

Again, there was a kind of nondescript character, who was a brakeman. He had red hair, a freckled, dingy face and a divergent strabismus, yet a head full of brains. When at work he was all work, devoted to discipline and very industrious until pay day came. When he had the accumulations of a month in his hand life to him became a continuous spree. When he again returned to duty, no one was more intelligent and effective than he. Being pleased with his bright, cheery, witty and intelligent character and his quaint, unique looks, we took a fancy to him and employed him upon one occasion to act as nurse to an injured man. At that time prescriptions were given upon a neighboring druggist. Being much engaged in attention to other cases, we neglected to notice the case in question and sent an assistant, and we both neglected to ascertain the quantity of brandy which was being used. Upon calling at the drug store, the druggist said: "Doctor, you certainly have not ordered all the

brandy which this injured man is using." We then casually asked him how much brandy they had obtained within the past thirty-six hours. "Why, sir," said he, "they have used nearly $18 worth of brandy, and your-red-headed nurse is thoroughly soaked with good drink." Upon going to see the patient, we found that both patient and nurse were thoroughly drunk, and in rather severe and forcible language dismissed the nurse and employed a new man. One day in going through the hospital, after having been absent for some six or eight days, whom should we seen in a bed in the ward, but the pale, pained and wan face of our old and illbehaving nurse. Looking up plaintively, he said: "Doctor, I have prayed for you to come, they don't seem to know what is the matter with me, and I believe that I am near unto death." In reply to inquiries he said: "I was standing in the L yard close to the platform, not thinking, when the engine struck me. I was caught between the platform and the engine. I felt my hip bones crush in. I dropped down in a dead faint. I know that something is wrong here, Doctor, I can hear the grating myself when I move." Upon examination it was found that he had sustained a fracture of the pelvis, with laceration and rupture of the urethra and urinary infiltration had already taken place. He was told that his recovery was doubtful and asked if he had not some friend or near relative whom he desired to see. He said: "Doctor, I came from a good and respectable family. I am what you call the black sheep of that family, but I have a sister who lives in Maine. She is as good and pure as an angel, and as sensible as Solomon--send for her." She was accordingly sent for, and when she came we found a real pleasant, common-sense, good woman. The patient was now approaching his end, and she was so informed, when she earnestly begged us to ask him whether or not he desired religious consolation. We asked him in her presence. He turned his head and looked up at her and said: "Sis, whatever Doc orders, by God, I will take."

Dr. C. A. Smith, chief surgeon of the St. Louis & Southwestern Railway, with headquarters at Tyler, Texas, has commenced a rather extended scale of bacteriological investigations concerning the plasmodium malariæ. His department is thoroughly well equipped for such work.