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such a stump is in no way better than a conical thigh stump.
It is said that if the patella can be securely fastened between the condyles, a good stump is formed, but as there is doubt about it being securely anchored there, I feel that it is not worth while trying it. Amputation of the leg can be done at any point from three inches below the knee to the junction of the middle and lower thirds, with the prospect of a stump which will be highly satisfactory to the manufacturer of limbs. When it is not possible to save three inches of the tibia, a knee disarticulation should be done. The lower third of the leg is a region unsatisfactory for amputations, as a conical stump is precluded. In leg amputations the fibula should be sawed off a little above the section of the tibia, except when within six inches of the knee joint, when it should be disarticulated, thereby making the stump more conical. The anterior corner of the divided tibia should be trimmed to prevent the sharp edge injuring the flap.
The different amputations through the foot and ankle have been the subject of much controversy for some time. I will not attempt to discuss them all with you, but will endeavor to make plain some settled points in regard to these operations. Chopart's, Heys', Lisfranc's and Forbes' operations have all been condemned by artificial limb makers as unsatisfactory in the majority of cases. Certain it is that they should not be attempted unless a long plantar flap can be secured and the cicatrix formed well upon the dorsum of the foot. The tendency after these operations is for the tendoAchillis to draw the heel up, as the opposing extensor tendons have been divided. When this condition occurs the tendo-Achillis should be divided. For this reason Lisfranc's operation is preferable to that of the others, as the insertion of the tibialis anticus into the internal cuneiform is preserved. I might say, however, that one manufacturer claims to have overcome all the difficulties arising from these operations, by means of an aluminum socket for the stump. Pirogoff's amputation is a fairly useful one, but is inferior to that of Symes. Symes' amputation is by far the most satisfactory operation in this region, and if properly done affords a stump which can be said to be perfect, in spite of all the criticism it has been subjected to. Prof. Stephen Smith
says that reamputation is necessary in three per cent. of the cases of Symes' operation.
Five years ago, at a meeting of railway surgeons, a maker of limbs of large experience claimed that amputation above the ankle was preferable. Many others have been positive in their condemnation of the Symes operation.
These men may be right in their assertions, because the cases falling under their observation were operated on under the original method of Symes, and it is described in the same manner in the text-books of to-day. The method to which I wish to direct your attention is that of Dr. W. H. Hamilton of Pittsburg, which is generally adopted in Western Pennsylvania, and which has never failed, as far as I can learn, to turn out a stump which can be satisfactorily utilized by the artificial limb maker. A stump after this method is always an end-bearing stump and can support the weight of the body without any difficulty, and I have never seen one that would not stand pounding on the floor with a bare stump. I quote Dr. Hamilton's own words in describing his method:
"The foot being held at a right angle to the leg the point of a large scalpel should be introduced at the tip of the external malleolus and an incision made directly across the sole of the foot in the direction of the tip of the internal malleolus and terminated about one-half an inch before reaching it, or the incision may be made in the opposite direction if it suits the convenience of the operator better. The extremities of this incision should be joined by one directly across the front of the ankle; this incision should arch slightly upward and not downward, as represented in some of our works on surgery, for so much tissue is taken from the sole of the foot that when the stump is dressed the integument from the sole should extend an inch at least above the plane of the lower ends of the leg, and the cicatrix be above the line of pressure. These incisions should be made directly down to the bones by the first sweep of the knife. The ankle joint should now be opened, the ligaments divided, and the dissection of the flap made from above downward; the thinness, softness and pliability of the tissues at this part facilitate the dissection. The dissection at the sides of the os calcis should be kept in advance of that at its posterior part which permits the division of the tendo-Achil
lis. The separation of the flap from the plantar surface of the os calcis then becomes the least troublesome part of the dissection. The dissection should be carried so closely to the osseous surface as to separate the periosteum, and no vessels should be divided after the first incisions, except the nutrient vessels of the bone, as every touch of the knife can be plainly seen by the operator. As soon as the flap has been separated from its attachments, the soft tissues should be separated from the outer sides of the malleoli, and they should be sawed off obliquely, the saw being applied on the articular surface at their bases and the direction of the cuts made upward and outward. The articular surface of the tibia should be left uninjured. The dissection of the flap should be made with a short scalpel, and it is well to have more than one such knife, as cutting close to and sometimes into the os calcis readily spoils the edge of the scalpel.
"The anterior tibial artery may be readily found and secured by torsion, and but little trouble will be experienced in controlling the hemorrhage from the other vessels, as any bleeding will be from smaller vessels which may be controlled by the application of artery clamps or other means.
“A very important part of the operation is that of dressing the stump. If the directions have been closely followed the integument of the heel flap will be found to extend almost an inch above the lower ends of the bones when placed in position, the tissues in front of the ankle. having retracted. Sutures should now be introduced about one-half an inch apart; they are not required to draw the parts together, but merely to keep the edges of the incision in line. Fine metallic sutures should be used and care
taken to have the heel part of the flap directly
under the bones of the leg; by using wire for sutures if portions of the skin are turned in or not approximated closely enough a suture may be tightened or relaxed as indications require. Strips of adhesive plaster should be passed over the ends of the stump between the sutures, which should make firm pressure on the flap and be secured to the leg above its middle, thus making any cavity requiring drainage impossible. The usual aseptic precautions having been observed and dressings applied, absolute healing may be expected in from two to four weeks, according to the care exercised in ap
proximating the edges of the incision. The sutures may be removed in ten days and the alhesive plaster be allowed to remain a week longer."
You will note that Dr. Hamilton's operation differs from Dr. Symes' in that the anterior incision is slightly arched upward, and that the sole flap is a little larger than Symes'; that the joint is opened in front and the dissection made from above downward instead of from below upward as in Symes'. The greater ease with which this can be accomplished can be appreciated only after a trial of both methods. You will also note that the articular surface is left undisturbed, and not sawed off, as in Symes' operation, a point I wish to emphasize in all joint operations, and that adhesive strips are used over the stump, and that no drainage tube is used, points well worth remembering.
In conclusion I would sum up my remarks briefly as follows: Save all you can of the upper extremity, and all you can of the lower extremity, down to the junction of the middle and lower thirds of the leg. From this point to the shaft of the metatarsal bones, no amputation except Symes', done by Hamilton's method, should be done, until it has been more definitely proved that certain artificial limbs made for these operations are perfectly satisfactory.
J. B. MURDOCH, M. D.
In presenting the accompanying portrait of our beloved ex-president, Dr. J. B. Murdoch of Pittsburg, Pa., we regret our inability to obtain an adequate obituary notice, but the fol
lowing extract from a daily paper published in Pittsburg contains many facts which, perhaps, are not known to all of the members of the National Association of Railway Surgeons, who knew and admired Dr. Murdoch:
In the death of Dr. J. B. Murdoch, which occurred recently in this city, a wide circle of friends have suffered an irreparable loss. A man of such pronounced character cannot pass away without producing a vacancy which is profoundly felt by all who knew him. He leaves a most loving and sweet memory in the hearts of all who were acquainted with him. His was a singularly attractive nature-bright, cheerful, loyal and true-of whom it can truly be said, that, "None knew him but to love him,
none named him but to praise." To those who knew him it will mitigate their sorrow over his departure to know that his passing was painless and peaceful. Surrounded by his loving wife and children, the shadows lengthened, and the end was peace. "They thought him dying when he slept, and sleeping when he died."
Dr. Murdoch was born in Glasgow, Scotland, in 1830, and came with his father, who was a missionary of the Congregational Church, to Canada in 1833. He left Canada for the United States at the time of what is called "The Patriot War," and had since resided at Ballston, N. Y.. Catskill, N. Y., Oswego, N. Y., and Pittsburg, Pa. He took his degree as a physician from the College of Physicians and Surgeons, New York City, in 1854. During the year 1855 he was surgeon of the steamship "North Star," of the Vanderbilt line of ocean steamers, and from 1856 till 1872 he practiced medicine in Oswego, N. Y., where he was a member of the
Oswego County Medical Society, and its president in 1865; also a member of the New York State Medical Society. In 1861 Dr. Murdoch was made surgeon of the 24th Regiment New York State Volunteers. He was made Surgeon-in-Chief of his brigade, which consisted of the 14th, 22d, 24th and 30th regiments of New York. Volunteers, and served as surgeon of the brigade at the battles of Bull Run, Falmouth, Rappahannock Station, Sulphur Springs, Groveton, South Mountain, Antietam, Gainesville, Manassas Plains, Fredericksburg and Chancellorville. On his return to Oswego, at the expiration of his term of service, he was made surgeon of the board of enrollment of the 22d district of New York,
which position he held to the close of the war. During his residence at Pittsburg, Dr. Murdoch has been a member of the Allegheny County Medical Society, of which he was president in 1885, and a member of the Pennsylvania State Medical Society, of which he was president in 1888. He was made company surgeon of the Pittsburg, Cincinnati, Chicago & St. Louis Railway in 1876. He was attending surgeon at the Western Pennsylvania Hospital at Pittsburg, which position he held since 1872. He
was one of the charter members of the National Association of Railway Surgeons, and was made its president at St. Louis in 1889. He was a clinical professor of surgery at the Western Pennsylvania Medical College, Pittsburg, and also dean of the college and president of the board of examiners for the 22d congressional district of Pennsylvania.
Dr. Murdoch was a frequent contributor to medical journals of the country. Reports of his surgical clinics of the medical college have been made from year to year, and are published in the journal of the American Medical Association. His articles on the "Torsion of Arteries," for the arrest of hemorrhage, have been widely circulated, and it may be said that he did more to popularize this method than any other American surgeon.
A widow and five children survive him— three sons, Augustus P. Murdoch of Oswego. Dr. J. Moorehead Murdoch of Pittsburg, and William Murdoch, now a student at Yale University, and two daughters-Florence and Katherine.
While it is true that as a surgeon Dr. Murdoch will be chiefly remembered, of whom he stood in the front rank, to his immediate and best known friends his memory will be most
lovingly treasured as a man of broad nature and culture. His literary and scientific attainments were of a high order. He had a deep regard for truth, and although reserved in expressing his opinions, had a deeply religious nature, and had thought profoundly on all the questions of life and death. His trustful committal of himself to the hands of God and patient waiting for his summons were beautiful to witness. With the calmness, self-poise and bravery of the skillful physicians, he possessed a profoundly emotional and sympathetic nature. He was a "born poet," though he never "lisped in numbers" or expressed himself otherwise than in prose. Robert Burns, Sir Walter Scott and William Shakespeare were his favorite authors, from whom he loved to repeat from memory by the hour together. From his Scottish ancestors he inherited that ardent affection for "Auld Scotia," "The Land of the Mountain and the Flood," which is the characteristic trait of Scotchmen. As such he took a deep interest in the books of "Ian Maclaren," "The Days of Auld Lang Syne," and "By the Bonnie Brier Bush," which were a solace to him in his last hours. Dr. John Brown of Edinburgh, and Dr. Maclure of Drumtochtie, were characters in which he delighted, and with which his particular friends will ever associate him.
SIMULATION OF NERVOUS DISORDERS FOLLOWING ACCIDENTS.
BY PEARCE BAILEY, M. D.,
Consulting Neurologist to St. Luke's Hospital. Assistant in
At the present time persons who suffer injury in railway or other accidents rarely neglect to demand of the companies, or individuals responsible, liberal compensation. In the entering of such claims, it is the chance of success rather than the extent of injury or the social position of the claimant, which seems to exert the most important influence. At first, no thought of financial recompense may occur to the injured person. Few, however, are so poor in friends that they escape kindly suggestions as to the possibility of turning misfortune to good account. If the accident were noticed in the daily papers the patient will soon have his rights explained to him by enterprising representatives of the bar. A man was recently injured in New York late in the afternoon. Before eleven o'clock the next morning eight "accident lawyers" had called at the hospital to see him. The last hours of the unfortunate man
were passed in listening to the arguments of the attorneys who were going to secure damages for him if they got the chance.
None will deny the justice of claims for damages for injuries received through negligence of persons responsible. And if a man does not know what his rights are he ought to be told. But with the enormous increase in the past few years of the "accident business," it would be out of harmony with the times if all of the claims which are entered for injuries received were genuine. In claims for visible physical injuries there is little chance for fraud. A man cannot simulate a broken leg. Few are so mercenary or so poor that they will inflict upon themselves serious wounds in a way which will permit the mode of occurrence of such injuries to be misinterpreted. With the disorders of the nervous system the case is somewhat different. Many symptoms of nervous disease are entirely subjective, and permit no objective proof. To be reasonably certain of the existence of headache or backache or inability to keep at work, the physician must often be convinced of the veracity of the person who complains of them. Such symptoms as these are often genuine and cause great discomfort to persons who have been in railway accidents. How frequently these and similar subjective evidences of impaired nervous function are invented or magnified by the patient is a matter somewhat difficult to determine.
Claim agents and corporation lawyers believe that in the majority of accident nervous cases the symptoms are either feigned or grossly exaggerated. Physicians themselves are not unanimous as to the frequency with which these symptoms are real. It is not surprising that a claim agent, whose medical knowledge is, at best, superficial, and who is so constantly a witness of attempted fraud, should be skeptical as to the justice of claims based upon symptoms of indefinite character. Physicians, on the other hand, know that neurasthenia is a morbid condition largely beyond the patient's control, and they believe it less frequently feigned than is supposed by non-medical railway officials. This opinion is based upon the observation of persons who develop functional nervous symptoms as the result of accidents, and who, even when the question of claim or litigation does not enter at all, remain incapacitated for work during months or years. The
different opinions on this subject held by physicians and corporation officers may be accounted for by the different points of view. A claim agent does not appreciate the fact that traumatic neurasthenia may be a very obstinate and distressing affection when the patient asks for nothing but a restoration to health; and physicians forget that many impostors are so clumsy in their descriptions of disease that they are turned away from the claim agency without being referred to a medical man.
Physicians believe that the number of absolute simulators among the claimants who are referred for medical examination is not large. Trifling symptoms may be exaggerated, or some statements made which are not true, but in the large majority of cases there actually exists some disability or discomfort upon which the claim is based.
Large sums are paid annually for damages by railway and other companies. Corporations usually prefer to settle small claims than to defend suits. These facts tempt many to try their hand at increasing their capital by feigning disease as the result of accident. The adventures of the Freeman family, which have been recorded by the Association of Railway Claim Agents in a little pamphlet entitled, "Paralysis as a Fine Art," furnish the best proof that absolute fraud may not only be attempted, but be eminently successful.
The Freeman family consisted of father, mother and eight children, Polish or English Jews, all of unsavory reputation. There is no definite information regarding the frauds of the male members of the family, but the mother, Mary Freeman, and the two daughters, Jennie and Fannie, between January, 1893, and December, 1894, entered no fewer than nine claims for damages against railway companies. That the last claim was fraudulent and the pretenses false, each and all of these three women swore before a notary in Chicago at the time of their final exposure. There is convincing proof also that all previous claims had been equally fictitious. An outline of the individual frauds is as follows:
Jennie Freeman, 18 or 20 years of age, of questionable morality and usually on good terms with some physician or attorney. Has been arrested for theft.
I. January 9, 1893. Claim on the Chicago City Railway Company. Collision be
tween two cable cars. "Alleged total paralysis from thighs down, loss of sensation, want of control of the bowels and urinary organs, and pretended that she was a cripple for life. The company's physician thought the girl was shamming, although the symptoms were so closely simulated that it was apparently a real case of paralysis. Company paid $500, and Miss Jennie is said to have recovered a few days after the damages were paid."
II. October 5. 1893. Claim on Manhattan Elevated Railway Company of New York, for injuries received by falling against the car door of a Second avenue train while rounding the curve at Twenty-third street. Settlement of $125 to Jennie Freeman and $100 to her physician.
III. May 16, 1894. Claim on Boston and Maine Railway Company of having been injured by slipping on a banana peel while stepping out of a car at Prospect Hill station. She claimed that she had injured her back and other portions of her body by striking against the end of a seat. One hundred and twentyfive dollars was allowed in respect of these injuries.
IV. June 28, 1894. Claim on Illinois Central Railroad Company for injury received by being thrown against the back of a seat through the sudden stopping of a train. She alleged total insensibility of the lower part of the body, practically amounting to paralysis. Had a sore on her backbone, immediately above the top of the corsets. Alleged an inability to control her bowels, etc. Was settled with for $200.
V. September 10, 1894. Alleged to have fallen from her seat while rounding a curve on one of the lines of the West Chicago Street Railway and represented to the company through her mother that she was paralyzed. Fraud discovered by the claim agent.
Mary Freeman (the mother), aged about 43 years, dirty, "a veritable Fagin unsexed." Has. been arrested several times for theft.
I. September 11, 1894. Claim on Chicago City Railway Company for injuries caused to her right arm by the sudden starting of a car. She received $100.
Fannie Freeman, aged 18. "Has little to say and acts the part of the paralyzed lady." Has been arrested for theft.
I. April 20, 1894. Claimed to have