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Notes, News and Personals.
Sir Joseph Lister has been made a Peer and is the first medical practitioner called as such to the House of Lords.
Prof. Wm. H. Pancost, the distinguished surgeon, died at his home in Philadelphia, January 4, 1897, at the age of 64 years. He was born in Philadelphia in October, 1835, and graduated from the Jefferson Medical College in 1856. After three years of post-graduate work in London, Paris and Vienna, he established himself in Philadelphia and soon became known as a bold and brilliant operator. During the war of the rebellion he served as a surgeon and in 1874 was elected to succeed his father in the Jefferson Medical College. In 1886 he became Professor of Surgery in the Philadelphia Medico-Chirurgical College.
The trained nurses have organized an association known as the Trained Nurses' United Aid Society of America. The object of the society is to relieve the members whose professional activity is suspended on account of sickness or accident, and in cases of death the payment of a funeral benefit. It is also proposed to establish homes of rest, to loan money in cases of temporary need, to endow beds in hospitals, etc.
Dr. T. G. Wormley, professor of Chemistry and Toxology in the University of Pennsylvania, died on January 3 after a lingering illness. He graduated from the Philadelphia Medical College in 1849 and in 1852 became professor of Chemistry and Natural Science at Capitol University, Columbus, O. He was also professor of Chemistry and Toxology in the Sterling College from 1854 to 1857. In 1887 he accepted the chair of the medical department in the University of Pennsylvania.
It is said that Dr. Wm. Pepper has succeeded in skiagraphing a number of aortic anuerisms. It is presumed that shadows are produced by the blood and its contained iron.
The physicians of Yarmouth, England, recently banded together and demanded higher fees from the benefit associations and restricted the limitations of the class of patients to be attended at clubrates. The associations also combined, and finding that they provided $10,000 worth of business a year, established an office of their own in the city and hired a doctor from out of town to manage it.
A certain tea-merchant of St. Johns, N. B., in 1892 sued the Pullman Palace Car Company for $20,000 for a severe cold which he caught in a Pullman palace sleeping car. The case has recently been decided in favor of the Pullman Company.
Notices and Reviews.
Essentials of Physical Diagnosis of the Thorax. By Arthur M. Corwin, A. M., M. D.; Demonstrator of Physical Diagnosis in Rush Medical College; Attending Physician to the Central Free Dispensary, Department of Rhinology, Laryngology and Diseases of the Chest. Second edition revised and enlarged. Philadelphia: W. B. Saunders, 1896.
This little book was originally written as an outline for the guidance of the author's classes. in physical diagnosis, but the immediate popularity of the first edition has induced him toprepare a second enlarged and revised edition. No claims are made for originality, the design being rather to present known facts and methods in a more or less graphic arrangement, enabling the student to catch and retain easily the points to be impressed.
The author has sacrificed, no doubt intentionally, all attempts at style and literary form for the sake of presenting the greatest number of facts in their proper sequence and co-relation in the smallest possible space and with the fewest possible words.
He states in his preface that he has drawn from the standard works on diagnosis, general medicine, physiology and anatomy for the factswhich he has presented and a more or less careful search fails to reveal any important errors. Possibly some points could have been more firmly impressed with a little more elaboration,
but as a whole the language is clear as well as concise, and the statements are positive.
The press work and binding are characteristic of Mr. Saunders and as usual all that can be desired.
The Electro-Therapeutist, a monthly journal of electricity, as applied in medicine and surgery, edited by Dr. Wm. F. Howe, Ph. D., and published in Indianapolis, Ind., is the latest candidate for professional favor which has reached our table.
No. 1, Volume 1, contains a practical paper upon "The Use of Electricity in the Examination, Diagnosis, Prognosis and Treatment of the Nose, Throat and Ear," by W. Scheppergrell. Also condensed facts for the general practitioner, besides editorial matter and “electro-miscellany." It strikes us that there is a field for just such a journal as the ElectroTherapeutist and we wish the baby well.
The editor will be assisted in his work by C. A. Burn, M. D., Richmond, Va.; Wm. Scheppergrell, M. D., New Orleans, La.; J. Mount Bleyer, M. D., New York, and Wm. H. Walling, M. D., Philadelphia, Pa., associate editors.
The following letter, which hardly requires comment, has been received from Dr. George M. Gould, editor of the American Year-Book of Medicine and Surgery, and until recently editor of the Philadelphia Medical News. The action of Messrs. Wm. Wood & Co., which, so far as we are aware, has not been explained, is scarcely comprehensible and shows not only an extreme selfishness, from a scientific standpoint, but a manifest business shortsighted
To the Members of the Medical Profession:
I would be pleased to have an expression of opinion from you, either personally or through some medical journal, as to the relations of the lay publishing firms of medical journals and the profession. The request is suggested by the fact that Messrs. Wm. Wood & Co. of New York refuse to permit the editors of "The American Year-Book of Medicine and Surgery" to use in our abstracts of Medical Progress articles and illustrations first printed in the "Medical Record" and the "American Journal of Obstetrics."
This decision seems to me to be wrong for the following reasons:
1. It prevents the dissemination of medical knowledge. The Year-Book condenses, systematizes and criticises the year's medical work in a shorter space and more permanent manner than the journals, and has thousands of readers no single journal can claim, or hope, to reach. Every physician writes and publishes articles in order that every member of the profession may, if possible, learn of his work, and that science and progress may thus be furthered and humanity benefitted. To interfere with such dissemination of our literature in reputable publications is, I think. discourteous and unjust to the profession and an injury to medical science.
This injustice and injury to medicine. become all the more striking when physicians do not receive a cent of pay for contributions, from the publication of which the lay publisher is supposed to make considerable financial profit.
3. No other publishers in the world, not even those who pay authors for their contributions, have in the least objected to our reproduction of quotations, abstracts and illustrations from their journals.
Do you wish to limit the dissemination of your contributions to medical science by such an exclusion of them on the part of publishers from reputable publications? Is this literature the property of yourself and of the profession or not? Does your gift of it to a journal make
THE RAILWAY SURGEON.*
BY J. W. WRIGHT, M. D., COLUMBUS, OHIO.
I reside in a part of the country where we hear so much of "railway surgery" and "the railway surgeon" that one would imagine that the former was a special science per se, and that the latter must be the possessor of a certain definite technique peculiarly adapted to his particular occupation. This idea has prevailed to such an extent that societies ad infinitum have been organized and have multiplied with the rapidity and thriftiness of the Canada thistle until the surgeon who is so unfortunate as not to be employed by some railway company as "chief surgeon" or "consulting surgeon," or even in the menial capacity of "company's surgeon," feels himself isolated and not fit companion for these select. We have two national associations of railway surgeons, as you are well aware. One was not enough, and for some reason another had to be formed. Then there are state and district associations galore and each system or company, however small, is in possession of an organization of its surgeons.
I do not take up this subject for the purpose of presenting a grievance against medical and surgical societies which have the good of the profession at heart, for these societies when properly conducted should be fostered. My object is to assist in ridding ourselves and the profession of a senseless fad. "Railway surgeon," "railway surgery," "railway hospital," "railway spine," "railway shock" and an exuberant number of synonymous expressions are constantly buzzing in our ears until we are almost deafened. Can you see where an amputation of a finger or a hand that has been
Read at the meeting of the B. & O Railway Surgeons' Assoiation, held at Philadelphia, Pa., June, 1896
mangled between the bumpers of freight cars differs in any respect from one in which the injury was received in a machine shop or elsewhere? Differentiate "railway spine" from any other? Wherein does "railway amputation" differ from others? There has been so much of this "stuff" (it can be called nothing else) that the railway companies are becoming heartily sick of it, and the officials of some of the larger systems are looking into the matter in a way that will not be very pleasing for a few who are riding this hobby. Let us look at this matter for a moment. Take the B. & O. system, for instance. It is a good one and we are all proud of it, but I am afraid some of us think we own it. We don't, however. But let me show you how it is imposed upon by these societies. The B. & O. Railway Surgeons have two meetings a year, one a business meeting and the other a semi-business and semi-social meeting. We are to ask for passes for ourselves and wives to both of these meetings. One of these meetings in the summer, when we all need an outing, is sufficient, and at that time all necessary business can be transacted. Then there are the national associations-two meetings. All surgeons on roads tributary to the B. & O. expect passes over it to these meetings. Then the same thing is expected by the members of the state societies. Don't you think the B. & O. and the Pennsylvania and other large systems are being imposed upon, and don't you believe that we are assisting others to impose upon them by lending our aid to these different organizations?
As a rule, those who conceive and foster national and state railway surgeons' associations and railway journals have not the interest of surgery nor of the surgeons, nor even of the railways, at heart more than to make for themselves a means of reward in one way or another. Any good surgeon is a good railway surgeon, and that is the whole business in a nutshell.
As I indicated before, I have no grievance against medical and surgical associations when they are organized for scientific purposes. I think every physician and surgeon should be a member of a local medical society, of his state medical society, and, if convenient, of the American Medical Association. He should certainly be a member of his local medical society, because he should foster the friendship and fellowship of his professional colleagues with whom he is coming in constant contact, and of the state society because it is a factor in legislation. A well organized state society can do more to bring about good sanitation and effective laws for the suppression of quackery than all other combined organizations and influences. He should be a member of the American Medical Association for patriotic and professional reasons combined. A few days' rest and recreation in attendance upon the greatest medical association in America. after a year's hard work does much to invigorate one and tends to give one more confidence in his own abilities.
I am in favor of a junket once a year in seasonable weather, and I am sure that the company we serve will do all in its power to make it pleasant for us. As far as the real business necessary to this association is concerned, it can be transacted one hour. As the matter now stands, there are two meetings a year of three days each. This is preposterous when we come to consider that the directors of this road meet only once a year and transact all of their business in one day. There is no physician here who, in justice to himself and his practice, can devote so much time to these organizations; there is not enough money in it if we were paid in cash exorbitant fees, and I am sure that the company does not insist upon this sacrifice of time.
BY J. M. THORNE, M. D., MCKEESPORT, Pa.
Amputations in general should be done with regard for prothesis, or the art of artificial limb adjustment, for if an amputation be done never so nicely and the result be a stump to which an artificial limb cannot be adjusted, it is apt to
*Read at the meeting of the B. & O. Railway Surgeons' Association at Philadelphia, Pa, June, 1896.
bring discredit upon the operating surgeon; therefore it behooves us, as railway surgeons, to make a study of prothesis and familiarize ourselves with artificial limbs, their points of bearing, and the most satisfactory place for amputation from the point of view of the artificial limb maker. It is not my province to discuss the different makers and their wares, but rather to point out the strictly surgical features of the subject by discussing, briefly, first stumps, then the different amputations.
When the stump has healed after an amputation, the first question we are asked is: "When can I be fitted to an artificial limb?” I would say the sooner the better. By disuse, the limb accumulates fat, enlarges and becomes flabby -a condition which wholly unfits it for the application of an artificial limb.
The effect produced by an artificial limb on a stump is to contract, harden and solidify the tissue, and a limb cannot be properly controlled by a stump which is not in this firm condition. Therefore it is best to begin treatment of the stump before the limb has accumulated fat, to prepare it for the artificial limb. As soon as healing is complete and tenderness does not prevent handling, massage, daily applied, and bathing will improve the tone of the tissue, then light bandages, preferably of rubber, should be worn constantly till all adipose tissue is crowded out and the stump is firm. As soon. as this condition is arrived at, the stump is ready to have a limb adjusted, and it is possible to get a stump ready as early as one month after amputation, though it usually takes longer.
Passive motion of the joints should be made so as to prevent anchylosis, and more especially to prevent the contraction of muscles from limiting motion.
In amputation through the shaft of a bone it is rare that the end of the bone is sufficiently protected to allow it to become one of the points of bearing in an artificial limb; therefore the weight is usually distributed over a considerable surface of the limb, as when amputation is done above the knee, the points of bearing are the whole surface of the conical thigh stump and of the tissues about the ischium; when below the knee, the points of bearing are the sides of the leg, the surface of the tuberosities of the tibia.
Amputation and disarticulation at a joint
produces an end-bearing stump, which is decidedly preferable to the inter-articular amputation, because, when the articular surface is preserved, it presents a surface prepared by nature for pressure, covered by a non-adherent skin.
Amputation should be performed high enough to insure healthy and sound tissue for flaps, except, perhaps, about the fingers and hand, where we might properly strain a point to save a most valuable member by leaving a surface to heal by granulation, provided we do not leave the bone uncovered.
A good rule is: "Enough muscle to cover the bone, enough skin to cover the muscle." Many prefer skin flaps. I like them only in amputations done on thin persons. When skin. flaps are used we should be careful to take the subcutaneous tissue with the skin down to the sheath of the muscle, as the nutrition of the skin depends considerably upon the subcutaneous tissue not being haggled. The flaps should be just long enough to fit neatly when sewed up, with a little to spare to allow for the natural contraction which occurs after the Esmarch bandage has been taken off the limb. The line. of union should never be over the sawed end of the bone, nor over any point of bearing, when possible to avoid it. A superabundance of flap is a disadvantage in the socket of an artificial limb. The bone should be sawed off squarely, and any prominent point or rough edges nipped off with the bone forceps. It is generally considered best to make a periosteal flap to cover the end of the bone, but I am not clear in my mind about the advantage of such a procedure. I have seen exostoses occurring from it, and I believe annular necrosis will not occur if the periosteum is carefully divided with a scalpel and the bone sawed off in the line of incision, the object being not to denude the bone of periosteum above where it is sawed.
The nerves should be retracted and cut off with a sharp knife so that their ends will be above bony prominences which might become pressure points. We should avoid bruising the nerves by grasping them with hæmostatic forceps.
Amputations done in the upper extremity should be governed by one rule, i. e., save as much in length as possible.
Prothesis has not accomplished much for the upper extremity. Any remaining parts of
the hand are by far more useful than any artificial hand ever invented. An artificial limb can appropriately be applied for any amputation between the hand and within five inches of the shoulder, with the expectation of its being quite useful. Parts of hands or fingers that are artificial are scarcely more than attempts. to cover up deformity. A limb applied to the shoulder is merely a matter of appearance. When amputation is done at the shoulder, the head of the humerus should be left in situ if possible, to preserve the natural contour of the shoulder, a matter which lends considerable to appearance.
. In amputating fingers, or parts of fingers, we should utilize palmar tissue for flaps as much as possible on account of its greater vitality and tactile sense, and to get the scar out of the way of pressure. Otherwise, any amputation done properly in the upper extremity should afford a useful stump to the artificial limb maker. It is in amputations of the lower extremity that prothesis has done so much for our patients, except for amputation at the hipjoint, and I believe every effort to adjust a limb to the trunk has proved a failure. In amputation of the thigh it is well to save as much in length as possible. A stump of four inches on the internal aspect of the thigh is as little as can be utilized for the adjustment of an artificial limb. It is in the thigh amputation that long flaps are of distinct advantage, as the points of bearing are the whole surface of the stump, except the lower end, and about the ischium, and the tendency is for the bone to protrude if any undue tension is brought to bear on the flaps. The line of union should be brought well behind so as to escape the region of the lower end of the bone.
A knee-joint amputation furnishes an endbearing stump, which is the most desirable stump possible. We should endeavor to have a long anterior flap, in order to get the scar well back of any pressure point. Do not trim off the condyles or any part of the articular surface. This is important. A skin flap over a smooth articular surface which is accustomed to bearing pressure is the condition most desirable, and such a stump can usually take all of the weight of the person on the end without discomfort. When the articular surface is removed the flap becomes adherent, making it incapable of taking scarcely any weight, and