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Officers of the N. A. R. S., 1896-7.
F. J. LUTZ, St. Louis, Mo.
W. R. HAMILTON, Pittsburgh, Pa.
.C. D. WESCOTT, Chicago, Ill.
J. N. JACKSON, Kansas City, Mo.; JAS. A. DUNCAN, Toledo, O.; J. B. MURPHY, Chicago, Ill.; S. S. THORNE, Toledo, O.; W. D. MIDDLETON, Davenport, Ia.; A. J. BARR, McKees Rocks, Pa.
We wish to call attention to a report by Dr. Lewis A. Stimson of New York, which we reprint from the Medical News, entitled, "The Intravenous Saline Injections in Conditions of Severe Shock." The cases which he reports demonstrate the value of this procedure, which we have already advocated in these columns and which we believe should never be omitted in the treatment of surgical shock, es
pecially where there has been much hemorrhage. The technique is so simple that the procedure may be resorted to under any circumstances where a piece of rubber tubing, an hypodermic needle, some boiling water and a little salt can be obtained.
We were surprised, in reading Dr. Chaffee's article on railway relief organizations, which is published in another column, to find that he had apparently forgotten the existence of The Railway Surgeon. This journal and The Railway Age, have, as the vast majority of railway surgeons will readily admit, been more forceful than all other instrumentalities combined in promoting the cause of railway surgery, railway hospitals and relief organizations of all classes. Indeed, The Railway Surgeon was founded for that particular purpose, and while other publications have done valuable service and are entitled to full recognition, we are surprised and pained to see Dr. Chaffee ignore the foremost exponent of the cause.
There is no more important subject connected with railway surgery than that of compound fractures, and so many of the injuries which the railway surgeon is called upon to treat are of this nature, the theme is always an interesting one. We are very glad to be able to republish, in this issue of The Railway Surgeon, a most excellent paper upon "The Treatment of Compound Fractures," by the president of the National Association of Railway Surgeons, Dr. F. J. Lutz of St. Louis, Mo., which he recently read before the St. Louis Medical Society, and which was first published in the Medical Review. Dr. Lutz is a practical and successful surgeon of large experience and can speak with authority upon any surgical subject.
Much interest was added to the last meeting of the C., M. & St. P. Railway Surgeons' Association by the presence of Dr. Solon Marks of Milwaukee, general surgeon of the company. The doctor, who is in much better health, by the way, than he was a year ago, took a lively interest in the proceedings and an active part in the scientific discussions. The remarks which he made upon fractures and their treatment, which we publish in other columns, are exceedingly pertinent and practical. In speaking of the duty of the railway sur
geon to his company, he says "He should guard the company's interest the same as he would his own, but while he is doing that he should not forget to be just toward all. There is no way in which he can serve his company better than by being just and truthful. He should observe his case attentively, so that if he is called upon to testify he can do so intelligently and conscientiously, and if called upon to testify he should try to appear before the judge and jury as an expert who is there for the purpose of telling the truth." These are words of wisdom and sound sense, and none can afford to ignore them.
STATUE OF DR. GROSS.
We are glad to learn of the successful casting, in Paris of the bronze statue, by A. Sterling Calder, of the late Professor Samuel D. Gross, for many years professor of surgery in Jefferson Medical College. As is well known the movement to erect a statue to this truly great surgeon was started by the American Surgical Association, of which he was the founder and first president. The necessary funds have been collected through the coop eration of the Alumni of Jefferson Medical College and a number of personal and professional friends. Congress has appropriated a sufficient sum for the erection of a suitable pedestal, and the monument is to be unveiled by a granddaughter of Dr. Gross during the Congress of Physicians and Surgeons, which is to be held in Washington in May of this year.
This statue is the second of its kind to be erected in this country to a physician and will be placed in the grounds of the Smithsonian Institution, near the Army Medical Museum, in Washington, D. C. The other was erected in New York some years ago to Dr. J. Marion Sims, a warm friend and contemporary of Dr. Gross.
It is often a subject of wonder that Americans have been so slow to honor in this way their great physicians and it is little short of shameful that the movement for the erection of the monument to Dr. Benjamin Rush has met with so feeble a response from the medical profession. May it not be due to the fact, however, that the physicians of this land, perhaps unconsciously, hesitate to put their hands in their poorly filled pockets for the honor of one
of their own number, whom the people at large should be so quick to glorify?
A REVIEW OF THE RELIEF AND HOSPITAL DEPARTMENT.*
BY DR. GEO. CHAFFEE.
History. The idea of the railway hospital was conceived and first put in operation in 1869 by Mr. A. N. Towne, vice-president of the Southern Pacific railroad.
This system is now in operation on the leading lines of the West, has reached the Atlantic coast over the Plant system and Chesapeake & Ohio, and its adoption is now under consideration by the Erie and other popular eastern lines.
The relief department proper was organized on the Baltimore & Ohio in 1880, and now has a surplus after sixteen years of $750,000. In 1882 the Plant system adopted its hospital department under the service of Dr. F. H. Caldwell as chief surgeon. On July 1, 1896, after selecting the most desirable relief features of the Baltimore & Ohio, the Plant system combined these features with its own hospital department, making what is considered an ideal relief and hospital department.
necessity and a comfort, a fact which applies A Necessity. In full health a home is a with as great force to the railroad man as to any other business man. If in health a home is a necessity, there can be no question in regard to the necessity of such when one is overtaken by an accident or sickness requiring experienced and skillful hospital treatment. When an employe is suffering from sickness or an accident, both he and his employer are anxious that he should be made comfortable and restored to health as fully and speedily as possible, and that no further injury or delay be caused by negligence or incompetency. In this respect the railway hospital system leaves nothing to be desired, hence it becomes a necessity.
The fact that we have "well equipped city hospitals along the line" is no argument or excuse against the adoption of the railway hospital system.
Our best surgical talent and the best results in surgery cannot be secured on lines where the hospital system is not in operation. On lines operating their own hospitals, the services of our ablest surgeons may be secured.
"Railway men take pride in direct contact, and it is in the nature of a curative measure for them to have their surroundings thor
* Read before the Annual Meeting of the Section on Railway Surgery, of the Medico Legal Society of New York City, Dec. 16, 1896.
oughly railroadish, and the homelike element of the railway hospital is the one which satisfies the railroad man.”
The relief and hospital department is a straight business proposition or transaction, founded upon business principles, having many beneficent features, chief among which is the humanitarian.
First Aid and Ownership.-First aid and first-class hospital service is provided, and from the time an injury is received until the case is dismissed it is under the care of specially trained surgeons. Uusually, except in times of a wreck, only railway men are trented at these hospitals. They own them and feel at home while in them.
Relief Cars and Transfer Features.-On the Plant system Dr. F. H. Caldwell has equipped a relief car for the transportation of the injured from the scene of a wreck to the hospital, and the sick and injured from one hospital to another. This is an economic, humane and up-to-date measure. It practically gives hospital treatment during transit, prevents pain and suffering, checks hemorrhage early, keeps the patient warm, saves time, and in surgery time is a life saver.
The transfer or interchange of patients from one part of the country to another will repay a thousandfold for any effort it may cost. It not only furnishes the employe with the best medical and surgical service in the land, including all specialists without extra charge, but provides for him, when indicated, a luxury which only those of means can afford, viz., transportation, change of climate and private hospital service until well.
Benefits and Relief Features. We reproduce a table from the relief and hospital department of the Plant system, showing the monthly contributions made by the employes and the benefits they receive in
system receive the same insurance as do members of the Brotherhood of Locomotive Engineers, at a trifle less cost, with the many benefits of the hospital thrown in.
An Economy.-The relief and hospital department is in many ways a protection to employer and employed, annually saving thousands of dollars for both, hence it is an economy.
Ón lines where the hospital system is not in operation employes annually subscribe for the relief of their sick and injured fellows many times the amount of their contributions where the hospital is in operation. It costs the employer and employed less to maintain the railway hospital than to do without it. Experience has shown that in a railway or company's hospital it costs from forty to sixty cents a day to treat and care for an employe, whereas in a city or contract hospital the cost is from a dollar to a dollar and a half. The
employe cannot secure the same care and attention in a contract hospital that he is sure to receive in the company's hospital. The railway hospital system prevents litigation by favoring compromises, prevents many annoyances, elevates the morals and the social standing of employes, the "tie that binds" is drawn more firmly, and we like each other better for it.
The railway hospital system under a staff of competent surgeons ever stands as a barrier between the claim department and those who would attack it from behind the popular mask of alleged injuries. One of the most popular and economical features of our great railway systems is their relief and hospital department.
How Maintained. The reliet and hospital department is maintained in some cases by endowments, in others by annual or monthly contributions from the corporations and by monthly contributions from the employes. In opening the department most corporations. leave it optional with their old employes as to whether they shall make monthly contributions or not to the hospital fund. On the Plant system this plan was followed, and since July 1, 1896, out of nearly six thousand employes 98 per cent of them have applied for membership and made voluntary contributions. The Plant system contributes one thousand dollars monthly to the expense of the department, pays the salary of its chief surgeon, and President Plant personally guarantees to make good any deficit which may The chances are that Mr. Plant will not be called upon for that purpose.
The Press. It was reported that when Pompedius Silo, an officer of the greatest eminence and authority among the allies, said to Maurius, "If you are a great general, Maurius, come down and fight us," he answered, "If
tion most favorable for the highest and noblest action of the human mind.
The inspiration which we shall receive when reduced to words will not differ materially from the Golden Rule.
While resting on this eminence let us glance along the various railway lines of this wonderful western country, and what shall we see? From Niagara and the Natural Bridge on the East, to the Golden Gate on the West, and from Mexico to far off Manitoba, all up and down those great western valleys and mountain ranges grand and beautiful scenery will meet the eye, and if we look a little closer we shall see the well equipped trains of many corporations winding their way along those valleys. By whom are these magnificent trains operated? By our noble railway employes who are in nearly every instance members of the hospital department, and many of them are also members of the Young Men's Christian Association. A sight well worth the effort of the journey.
On our return let us stop off at the highest point in our own Catskills. After looking down the historic Hudson toward Greater New York, and surveying the country from Niagara to Maine, what do we find? Only on the Long Island and Lehigh Valley do we find any form of relief that approaches the hospital system.
Our thoughts have been carried to a high plane, and while resting there an opportunity is presented for one of our number to do a charitable act of the highest order by endowing a railway hospital, the effects of which are not local or for a day, but will be appreciated by employes and looked upon by the entire railroad world, its beneficent effects lasting through time. We have reviewed our work of 1896 step by step, during the year we have taken those in a position to found railway hospitals along the hospital pathway until we have reached this high plane, and here we leave them, not alone or in danger, for we leave them as we found them, with their God-International Journal of Sur
By a general order the position of chief surgeon of the Vandalia system has been abolished. The following list of local surgeons on the main line has been promulgated: J. W. Marsee, Indianapolis; Amos Carter, Plainfield; E. B. Evans, Greencastle; J. F. Gillespie, Reelsville; J. B. Thornton, Knightsville; Joseph Gifford, Brazil; P. H. Veach, Staunton; S. M. Rice, Terre Haute; O. Mitchell, Marshall; W. W. Bruce, Casey; J. B. Walker, Effingham; C. W. Durst, St. Elmo; R. E. Beach, Vandalia; W. T. Easley, Greenville; W. M. Tibbetts, Highland; J. L. R. Wadsworth, Collinsville; H. C. Fairbrother, East St. Louis.
Extracts and Abstracts. as we would an operation for the amputation of
a limb, or the performance of a laparotomy, becomes at once apparent. I wish also to call attention to the fact, well known but often overlooked, that in the injury which we designate a compound fracture, the wound of the bone is by no means the most prominent injury, and by no means the one to which attention should be paid to the exclusion of all other injured structures.
I. First, as to cleanliness.-The statement that every compound fracture is an infected wound will require but little modification. The manner in which it is inflicted, the natural surroundings of the injured part and the contact of the wounded surfaces with these surroundings are ordinarily of a character to furnish the conditions for infection. The manipulations necessary to remove the materials in contact with the wounds which may produce sepsis should be of so thorough a character as to insure, as far as possible, the asepsis of the patient, and will therefore in all the more serious cases require the administration of an anæsthetic. I am not discussing at his juncture anything but the cleansing of the injured part; to do this, soap, hot water, a brush, ether or turpentine and the razor may all be necessary. Whatever means are employed, the wound and its surroundings should be completely and thoroughly freed from dirt. A person sustains a compound fracture of the leg, the ends of the bones protrude through the skin, and having been pressed into the ground are, as a rule, brought back into apposition as though this was the first indication to be met, and little thought is given to the well-known fact that micro-organisms enough have been introduced with the reduced bone to set up a violent infection of the tissues and of the system, to be the source of danger to the limb of the patient as well as to his life. For the purpose of being enabled to thoroughly cleanse every portion of the wound, the cutaneous opening or the rent in the fascia should be freely enlarged and the exposed and contaminated surfaces should be freely irrigated and scrubbed until nothing remains which can be removed. I intention
ally omit discussing whether or not antiseptics are of much importance in the first treatment of fractures. Personally, I have for several years discarded their use except in specific instances, and have found that hot water answers every purpose. The emplovment of antiseptics, especially in the dressing of compound fractures has, as in dressings for other purposes, often been substituted for surgical cleanliness, and in many instances the practitioner believes that he has done his full duty when he has wrapped a liberal quantity of iodoform and bichloride gauze around a compound fracture, while the tissues underneath have not received his careful attention.
II. When considering the re-establishment
The Treatment of Compound Fractures.*
BY F. J. LUTZ, M. D., ST. LOUIS, MO.
No subject could be of greater importance to the general practitioner, as well as to the patient, than a correct knowledge of the treatment of compound fractures. No error is more common than to suppose that anyone is competent to take care of a case of compound fracture, and in no class of cases is an unfortunate result so universally attended with reproaches to the practitioner, and in many instances with disastrous results to the patient so far as his future usefulness is concerned. It will therefore not be considered inappropriate to discuss in a general way the principles which are well recognized as being fundamental in the treatment of these injuries, even though by doing so we depart from a practice which seems in vogue in medical assemblies, according to which the unusual and uncommon are given preference over that which is of everyday occurrence, and therefore of everyday usefulness.
I take it for granted that there will not be much dissent among those whose views are based upon experience and observation that the following procedures may be considered a safe basis of procedure in all cases of compound fracture:
First, cleanliness; second, re-establishment of normal relationship of injured structures; third, drainage; fourth, immobilization. Their applicability is modified only by the peculiarity of the fracture. The means wherewith these various indications are to be met differ with different surgeons, and the indication for their employment may be subject for debate. If this evening's discussion will bring out more prominently the various points, the session will have been well spent and I trust some good will be accomplished.
Permit me briefly to review the methods and indications for the use of the procedures and manipulations above spoken of. I wish to premise, that in my experience, by no means limited to the observation of my own work, but in which I have been enabled to witness that of others, I have found that the general practitioner, as a rule, agrees with the laity and does not consider the procedures necessary in the first treatment of a compound fracture the equivalent of a capital operation. Since it is well established that the prognosis in a case of compound fracture depends almost exclusively upon the first treatment, the importance of so conducting this first treatment.
*Read before the St. Louis Medical Society, Nov. 21, 1896, and reprinted from the Medical Review.