Billeder på siden

enabling the surgeon to accomplish relief of the deformity, free exposure, such as I have just been advocating in recent fractures, is the proper treatment.

A similar method of dealing with luxations which are not readily reduced by manipulation under anæsthesia is, in my opinion, preferable to a long continuance of unsuccessful manipulations, the application of great power by apparatus, or a relinquishing of the attempt to restore the integrity of the joint. It is true that in all dislocations, except those of the spinal column and the backward luxation of the second phalanx of the thumb, reduction is usually readily accomplished by skillful manipulation under anæsthesia, provided the attempt is made while the injury is recent. My contention is that in recent dislocations, when this is not the case, and in old dislocations, arthrotomy should be promptly done. No surgeon would recommend allowing the displacement to remain without attempting reduction, and I believe that compound pulleys or other methods of applying great force are usually more risky than prompt and thorough exposure by incision. Immediately before making the incision it would be well in most cases to make a final effort to reduce by manipulation; but this should not be carried to a sufficient extent to cause much bruising or muscular laceration. The presence of such traumatism would increase the liability to septic processes, if imperfect asepsis allowed germs to gain access to the wound during the operation.

Arthrotomy for irreducible dislocation is not a novel suggestion, for it has been repeatedly done by many surgeons in old injuries. It has not, however, I think, been often adopted until after vigorous efforts have been made to subcutaneously replace the separated articular surfaces. Its use in luxations a few hours or a few days old, except perhaps in the fingers and toes, is probably almost unknown as an accepted surgical procedure. I believe it ought to be the approved treatment in a small number of cases. The advantages of the open method will at once be patent when the accidents that occasionally follow the employment of the older methods are recalled. Fracture of the bone or laceration of artery, vein or nerve is only likely to occur when the region is not exposed to the operator's eye. In case of impossibility to properly reduce the dislocation, moreover, the end of the luxated bone can be excised. This will probably nearly always give a better functional result than to allow the previous condition to persist. Excision is not infrequently required after attempts to reduce old luxations without incision have proved unavailing. In an attempt to reduce an old luxation of the humerus I have displaced the head of the bone in such a way that it rested on the

brachial plexus and caused more trouble than the original deformity. This would not have been the result, I think, if I had exposed the luxated bone by arthrotomy. If the open treatment is to be adopted it is evident that the patient will receive the greatest advantage if it be instituted before the head of the bone is altered in shape, the socket changed, and muscles and fascia contracted or adherent to surrounding tissues. The open method in addition gives opportunity to divide any ligaments, tendons, fascia and muscles which restrain reduction, to scrape out any material filling the socket, and to make provision for preventing recurrence of dislocation by retrenching the capsule or other plastic measures.

Skiagraphy may have a field in this department of surgery, as in fractures, by indicating the charcter of the luxation before the incision is made. It may perhaps be urged to this plea for a more general employment of exploratory incision in closed fractures and dislocations that there are great objections to making a closed lesion of the osseous system an open


I know of no objection except the risks inherent in anæsthesia. the possibility of infection, the occurrence of serious bleeding, and the production of ankylosis. The objections are of no force when the injury is one requiring exploratory incision. Anæsthesia will have been used in such instances for diagnosis or attempted reduction. Its moderate prolongation for the necessary time will add practically nothing to the risk. Bleeding is no contraindication except in that rare condition, hemorrhagic diathesis. Ankylosis is more. liable to occur from displaced fragments or articular surfaces, irregular callus due to stripped up periosteum, and interference with articular contact, than from aseptic incision into the joint and readjustment of the joint structures. The possibility of infection is, then, the only factor that requires consideration. Fifteen or twenty years ago, even subcutaneous tenotomy at the heel, recommended by the surgeons of the Pennsylvania Hospital in cases of marked displacement after fractures of the tibia, was undertaken with some hesitation. Now operative infection in muscular and osseous lesions is so preventible and so readily managed by prompt action that it is no longer a valid objection to incision in a closed fracture or dislocation, if functional disability is liable to occur unless this operation is performed. For some years it has been the practice of surgeons to incise open fractures freely in order to thoroughly cleanse the deep recesses, obtain an antiseptic condition of the lesion, and get rid of effused blood. An extension of operative surgery is, in my opinion, now warranted in closed fractures and dislocations in which ordinary

[blocks in formation]

When the displacement is great, a splint can be applied direct to the fractured clavicle, in persons who are lean and the bone very prominent, as follows: Take a piece of Hood and Reynold's dental modeling composition, soften in hot water, flatten it out to a proper thickness and cut into a strip the length and breadth required, soften again in hot water and dry with a towel; then press or mold it firmly over the clavicle while holding the parts in apposition, exhausting all the air. It acts like a cupping glass; it will stay and not irritate the skin. Apply the sleeve bandage. In children there will be complete union in from twelve to eighteen days; in adults, in from thirty to forty.-Edward Borck.

Rights of the Surgeon.

A recent decision in the London courts involves a point of much importance to all physicians. A hospital nurse brought action against an eminent London surgeon, Dr. Charles J. Cullingworth, for performing the operation of double ovariotomy, when positive directions had been given not to exceed the single operation at the most. As a result of the double operation the plaintiff felt she must break an engagement of marriage. The question at issue was, Is it a medical man's right or duty to override the known wishes of a patient, even in the best interests of the health or life of the sufferer? Sir Thomas Spencer Wells, Lawson Tait and other leaders in the profession testified that they would not undertake to perform any operation under such restrictions as the plaintiff said she had imposed. The operating surgeon declared that when the plaintiff consented to the operating table, she tacitly consented to anything he thought best. However, he remarked to those about the operating table that he hardly knew what to do; a double operation was certainly indicated, and yet, considering the patient's wishes, the case

presented grave and unusual complications. The doctor testified that the plaintiff might have lived for many years, if he had not operated, but in his opinion, the double operation was necessary for a radical cure. There.fore, he proceeded with the complete removal of both ovaries. The jury brought in a verdict in favor of the defendant. Yet it must be admitted that the surgeon was not altogether free from blame. The mistake was in undertaking an operation under such restrictions; but having agreed to the conditions, according to the plaintiff's testimony, it is certainly questionable how far these wishes and directions should be set aside.-National Medical Review.

Fees of Austrian Profession.

Everyone knows that in the German universities the professor is paid by his students, and that his fees represent the greater part of his benefits. The Austrian government, notwithstanding the resistance of the majority of doctors, has just decided to modify this state of things by presenting a bill which regulates the salary of the professors of a university. This bill suppresses the fees of students to professors and allots the payment of professors directly to the government. Students will not pay less, but they will pay to the government and not the professors. This is the French system. The professors who teach abstract matter (théoriques) and who have small audiences will profit by this change, but others, and particularly professors of clinics, who have from three to four hundred students, will see their revenues considerably diminished. It is to be feared that these professors will no longer hesitate to respond to calls from German universities, and on the other hand that German professors will refuse henceforth to accept a chair in an Austrian university. The new law would be fatal to the old fame of the medical school of Vienna.-Méd. Moderne.

Surgery and Vivisection.

A curious instance of the direct application of vivisection to practical surgery was related to the Linnean Society by Mr. J. D. Middleton. It is the custom in Smyrna to heal wounds by the help of ants. A friend of Mr. Middleton received a severe but clean cut on the forehead. He went to a Greek barber to have the wound dressed and the barber employed at least ten living ants to bite the two sides together. Pressing the margins of the cut with the fingers of the left hand, he applied the insect by means of a pair of forceps held in the right hand. The mandibles of the ant were widely open for self-defense, and as the insect was carefully brought near the wound,

it seized upon the raised surface, penetrated the skin on both sides, and remained tenaciously fixed while the operator severed the head from the thorax, so leaving the mandibles grasping the wound. The same operation was repeated until about ten ants' heads were fixed on the wound, and left in position for three days, or thereabouts, when the cut was healed and the heads removed. Sir John Lubbock, in his work on "Ants, Bees and Wasps," quotes from M. Mocquerys a passage which relates that the Indians of Brazil made use of this procedure in the case of wounds. He had often seen natives with wounds in course of healing with the assistance of seven or eight ants' heads. This surgical ant is the Atta æphalotes (Linn).-The Scalpel, December.

Doctors Should Not Be so Modest.

"I know that there is a general feeling among physicians of the better sort that conspicuous interest in public affairs may be misconstrued and looked upon as in some sort a means of professional advertisement. And one cannot choose but to appreciate and admire the sensitiveness and high sense of honor of which this sentiment is born. But, after all, there are greater misfortunes in life than being misunderstood, and I think that the fine feeling which leads the physician so often to waive the privileges of social and public life in the interest. of what he conceives to be professional ethics is capable of a richer fruitage yet, in the defiance of misconstruction, when impelled to whatever performance of public duty he can justify to himself." Dr. T. Mitchell Prudden, address before Yale Medical School.

Notes, News and Personals.

Dr. Hartwell N. Lyon has been appointed house surgeon to the hospital of the Big Four Railway system at St. Louis. Dr. Lyon's four years of hospital work in London, Berlin, Vienna, Paris and Heidelberg give him most excellent qualifications for the position he has assumed. We congratulate Dr. Lyon and the company which he serves.

Dr. James A. Minnich, surgeon for the Pennsylvania Railway Company, at Worthington, Ind., died, January 30, 1897, from pneumonia. Dr. Minnich was born at Carlyle, Ind., in 1831, and was educated in medicine and surgery in New York City. After he had graduated he returned to Indiana and settled at Worthington, where he practiced medicine for a number of years. He was a member of the Indiana legislature for two years, and afterward became connected with a surgical institute. He lived in Indianapolis for seventeen years, and a few

years ago returned to Worthington. His wife and five children survive him. Two of themMrs. Charles Railsback and Mr. Charles A. Minnich-live in Indianapolis.

Notes of Societies.

Twelfth International Medical Congress.

The American National Committee of the Twelfth International Congress, which is to meet at Moscow, Russia, from August 19 to 26, 1897, consists according to the directions. of the general committee at Moscow, of the following gentlemen:

J. S. Billings, New York.

F. J. Shepherd, M. D., Montreal. Geo. B. Shattuck, M. D., Boston. W. S. Thayer, M. D., Baltimore. Geo. F. Shrady, M. D., New York. Frank P. Foster, M. D., New York. Charles A. L. Reed, M. D., Cincinnati. S. Weir Mitchell, M. D., Philadelphia. A. Jacobi, M. D., chairman, 110 West 34th street, New York.

The chairman begs to invite the attention of the medical profession of the United States and Canada to the fact that the professional gentlemen in charge of the congress are anxious to make it a success both from a scientific and a social point of view.

Texas Railway Surgeons.

The fourth annual meeting of the Texas Railway Surgeons was held at Dallas, January 26 and 27, and the following is the program:

FIRST DAY-Tuesday, Jan. 26, 1897. Association called to order by chairman of committee of arrangement.

Prayer by Rev. Dr. Rankin.

Address of welcome, by Hon. Frank Holland, mayor of Dallas.

Roll call.

Reading of minutes of previous meeting. Treasurer's report.

Report of executive committee on credentials of applicants for membership.

Reports of standing committees.
Miscellaneous and new business.


President's address.

Reading and discussion of papers:

1. "Some Diagnostic Points on Intestinal Surgery, With Demonstrations," Dr. C. A. Smith, chief surgeon Cotton Belt Railway, Tyler.

To Open Discussion-Dr. H. C. Smith of

Denison, company surgeon M., K. & T. Ry. 2. "The Railroader's Nosc," Dr. R. F. Miller, oculist, Northern division Houston & Texas Central Railroad, Sherman.

To Open Discussion-Dr. F. P. Davis, Houston.

5. "Hemorrhagic Malaria," Dr. A. A. Bailey, Red, company surgeon Houston & Texas Central Railroad, Houston.

4. Subject unannounced, Dr. A. C. Scott, chief surgeon Gulf, Colorado & Santa Fe Railway, Temple.

5. "Hemorrhagic Malaria," Dr. A. A. Bailey, company surgeon Gulf, Colorado & Santa Fe Railway, Richmond.

To Open Discussion-Dr. J. R. Williamson, company surgeon Houston & Texas Central Railway, Brenham.

6. Volunteer papers and reports of cases. Program for the night session will be announced by the chairman of the committee of arrangements.


Reading and discussion of papers:

1. "Some Injuries to the Eye Found Among Railroad Men," Dr. E. P. Davis, oculist Houston & Texas Central Railway, Houston.

2. "Report of a Case of Appendicitis," Dr. J. R. Stuart, surgeon Houston & Texas Central Railway, Houston.

To Open Discussion-Dr. P. M. Raysor, Bryan.

3. Subject unannounced, Dr. A. A. Thompson, company surgeon Houston & Texas Central Railway, Waxahachie,

The following officers were elected for next year:

President, Dr. W. II. Monday; vice-presidents, Drs. A. B. Gardner, C. M. Rosser and G. B. Foscue; secretary, Dr. Clay Johnson; treasurer, Dr. A. A. Bailey; executive committee, Drs. R. F. Miller, G. B. Foscue and J. A. Lightfoot. The two former were reelected and the latter succeeded Dr. Monday, the newly elected president of the association.

Galveston was selected as the next place of meeting, on the second Tuesday in August, 1897.

Dr. Stuart, the retiring president, then rose and handed the gavel to his successor. Mr. Monday made a brief address thanking his associates for the honor.

The following gentlemen were named as a committee on transportation: Drs. Stuart, Scott and Jenkinson.

After some routine business the association adjourned.

The next meeting of the Medical Society of the Missouri Valley will be held at Lincoln, Neb., on Thursday, March 18, 1897.

Notices and Reviews.

Borderland Studies. Miscellaneous Addresses and Essays Pertaining to Medicine and the Medical Profession, and Their Relations to General Science and Thought. By George M. Gould, A. M., M. D., formerly editor of The Medical News. Philadelphia: P. Blakiston Son & Co., 1012 Walnut street. 1896.

Most of the readers of The Railway Surgeon are doubtless familiar with some of the essays or addresses which Dr. Gould has brought together in this attractive form. Some of them have appeared in the editorial columns of the Philadelphia Medical News, others in the Forum, the Monist, and the Open Court. Each bears the mark of Dr. Gould's individuality and must carry conviction to all of his earnestness and enthusiasm in regard to each subject. of which he writes.

Among the most noteworthy chapters are those on "Vivisection," "Medical Language," "Charity Organization and Medicine," "Hospitalism," "Everybody's Medical Duty" and "Dream Sleep and Consciousness."

For logical argument and keen analysis we can hardly conceive of anything stronger than the paper on "Vivisection," which was delivered at the American Academy of Medicine at Atlanta in May, 1896. To us it is absolutely unanswerable. We quite approve of him when he says: "Almost every point over which the controversy has raged most fiercely has been in relation to one or all of the three or four questions:

What is vivisection? By whom should it be performed? For what purposes should it be performed? By what method should it be carried out?

In reference to all of these questions scientific men should unite and establish a common set of principles or answers. In my judgment their failure to do so, and besides this, their frequent exaggeration of logical limits and just claims, has been one of the unfortunate causes of useless and wasteful wrangling.

Through many of the essays runs a vein of somberness, even of sadness, which has at times an appealing quality, indicating to us Dr. Gould's discontent with things as the and his heartfelt desire to stir all men to help make things better. His faith is so strong and so pure that to him it is immoral to doubt the facts of immortality and a divine origin of things. He deeply loves nature, animate and

inanimate, hates shams and conventionality and adores everything which is beautiful in nature and art. All these things bespeak the man which he really is, and no matter how one may differ with him in his metaphysical views, no one can read anything which Dr. Gould writes without being the better for it.

Much credit is due Messrs. Blakiston, Son & Co. for the mechanical execution of the volume under review.

Anatomy: Descriptive and Surgical. By Henry Gray, F. R. S., Lecturer of Anatomy at St. George's Hospital Medical College.

New edition, thoroughly revised by American authorities from the thirteenth English edition, edited by T. Pickering Pick, F. R. C. S., with 772 illustrations, many of which are new.

For forty years English-speaking students and physicians have relied upon Gray for the basis of their medical knowledge, and hardly any other text-book has been so generally used or has maintained for so many years its supremacy and excellence over other books devoted to the same subject. And, of all editions which we have seen, this last American edition is the best in every respect. It is really the result of a complete revision by men especially qualified to critically scrutinize its various sections, and the chapters on the brain, the teeth and the abdominal viscera have been rewritten.

One hundred and thirty-five new engravings have been added to those which have always distinguished this work by their clearness and accuracy, some of which are beautifully colored. In spite of the additions, both to the text and its illustrations, the price of the work has not been increased. It is still published both in colors and in black alone. The presswork is characteristic of Lea Brothers & Co., and could hardly be surpassed.

Don'ts for Consumptives, or Scientific Management of Pulmonary Tuberculosis. How the Pulmonary Invalid May Make and Maintain a Modern Sanitarium of His Home, with Additional Chapters Descriptive of How Every Consumptive Person May Apply the Forces of Nature to Assist and Hasten Recovery, and also How the Defects of Heredity May be Best Overcome. By Charles Wilson Ingraham, M. D., Binghamton, N. Y.: February, 1896. The Call, Binghamton.

The author states in his preface that the purposes of the book under review are to outline to the physician and pulmonary patient

[blocks in formation]

Practical Points in Nursing for Nurses in Private Practice, with Appendix Containing Rules for Feeding the Sick; Recipes for Invalid Foods and Beverages; Weights and Measures; Dose List and a Full Glossary of Medical Terms and Nursing Treatment. By Emily A. M. Stoney, graduate of the Training School for Nurses, Lawrence, Mass; superintendent of Training School for Nurses, Carney Hospital, South Boston, Mass. Illustrated with 73 engravings in the text and 9 colored and half-tone plates. Philadelphia: W. B. Saunders. 1896.

Most books of the character of the one under review have been anything but satisfactory from the standpoint of the physician. We are free to say, however, that Miss Stoney has succeeded wonderfully well in fulfilling the claims made upon her title page. The work is divided into seven parts. The first is devoted to: The nurse; her responsibilties, qualifications, equipment, etc. The second to: The sick room, its selection, preparation and management. The third to: The patient and the duties of the nurse in medical, surgical, obstetrical and gynæcological cases. The fourth: To nursing in accidents and emergencies. The fifth: To nursing in, special The sixth: To the nursing of the new born and sick children, and the seventh to physiology and descriptive anatomy.


Most physicians will certainly be satisfied

« ForrigeFortsæt »