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for one who has the previous six volumes, Notes, News and Personals.
brings surgery up to date and completes an
Diagnosis and Treatment of Diseases of the Rectum,
We are not unmindful of the fact that "criticism is a study by which men grow important and formidable at very small expense." All men assume the capacity to criticise, while few possess it, and they render manifest that which they should conceal, and that is their inability for the work they attempt. The average criticism in an average medical journal does not arise even to the average intellect possessed by the writer. Chimmie Fadden is by far a more interesting critic, and a more truthful and conscientious one than the critic in many medical journals.
Here is a book which offers, in consequence of many faults in diction, an unlimited field for the ranting critic to make his own grandeur apparent, while pulling down the author.
We are free to confess that these very faults make it valuable, for it certainly fulfills the purpose for which it was written. It is a plainly written, thoroughly instructive book, and the active practitioner can find in it digestible pabulum. It teaches and teaches well the very things a practitioner wants to know, and he is not compelled to wade through masses of theory, but finds in most unpretentious language the facts he wants to know. We predict that this book will have better success than many whose verbosity and pretension lead us to expect more than we get. The reverse is true in this book. We get more in an easy way than in almost any other book which we have read in a long time. The execution is excellent, the type is good, and the illustrations all that could be desired. The matter is condensed, readable and instructive and does not confuse one at the start by exceeding bulk. We are free to confess that a Falstaffian looking volume now seems to mean just so much sapped vitality. 0.
Dr. J. F. Valentine, chief surgeon of the Long Island Railroad, is organizing a hospital department for the employes of that corporation.
Dr. H. H. Mudd, Dean of the St. Louis Medical College, has been appointed consulting surgeon of the St. Louis hospital of the Missouri Pacific Railway.
Dr. T. O. Summers, editor of the St. Louis Critic, has been appointed Bacteriologist and pathologist to the hospital department of the Missouri Pacific Railway.
There are now thirteen railway systems in the United States having hospital departments in operation. These departments have twentyfive well-equipped hospitals, treating annually over 165,000 patients.
Dr. Donald Maclean of Detroit has resigned and Dr. Truman W. Miller of Chicago has been appointed to succeed him as chief surgeon of that portion of the Grand Trunk system west of the Detroit and St. Clair rivers.
The staff of the St. Louis hospital of the Missouri Pacific Railway attended to nearly 120 people, more or less injured, following the cyclone of May 27. All of this attention was supplied gratuitiously, for in such calamities as these, selfishness is an after consideration.
Dr. E. F. Yancey, chief surgeon of the M. K. & T. Railway, has just had constructed at the Sedalia Hospital a new and thoroughly equipped operating arena. This magnificent hospital has a capacity of 85 beds and the surroundings are very pleasant. It is situated in the middle of a splendid grove of trees, with all the air space which sixteen acres can give. Certainly every want which a patient can have can be supplied.
Dr. W. F. Jamieson of Palestine, Texas, chief surgeon of the I. & G. N. hospital department, has returned from New Orleans, where he has been attending various clinics. The doctor has brought his department to a high state of efficiency. The Palestine Hospital is a splendidly equipped and carefully constructed brick building with a capacity of about 65 beds. It is beautifully situated amidst rare plants and exotics and other pleasant surroundings.
The Missouri Pacific Hospital Department treated, through its consulting staff of specialists, the following number of patients during the past year: The oculists treated 452 patients. and these patients made 3,526 visits to them; 42 operations were performed by the oculists. The laryngologists treated 463 patients, with 1,290 visits and 205 operations. The aurists treated 255 patients, who made 566 visits and. had performed upon them 18 operations. The dermatologists treated 208 patients, who made 402 visits. The neurologists treated 168 pa
tients, who made 218 visits. The total number of patients was 1,546; the number of consultations, 6,011, and the number of operations 265.
Dr. C. M. Daniels of Buffalo, chief surgeon of the Erie Railway Company, has submitted to the employes of that system a most excellent plan for the organization of a hospital department. This plan possesses every element calculated to satisfy the most exacting. It is, indeed, a positive advance in the formation of a hospital department, and by its pure merit will satisfy everyone.
Dr. P. F. Vasterling, senior house surgeon of the St. Louis Hospital, Missouri Pacific Railway, has accepted the editorship of the Railway Surgical Department of the "Medical Fortnightly" of St. Louis. This is an excellent selection and will certainly redound to the profit of the "Fortnightly," as Dr. Vasterling is rich in railway surgical experience, and moreover an enthusiast in his profession.
The Columbus, Sandusky & Hocking Railway has organized a surgical staff and divided the system into surgical divisions. The following surgeons comprise the staff as now organized: Sandusky, Dr. C. H. Merz; Bucyrus, Dr. J. A. Chesney; Marion, Dr. A. M. Crane; Delaware, Dr. E. M. Semans; Columbus (chief surgeon), Dr. R. Harvey Reed; Basil, Dr. O. P. Driver; Fultonham, Dr. C. Z. Axline; Corning, Dr. C. B. Holcomb; Hemlock, Dr. B. F. Barnes; Shawnee, Dr. J. D. Axline; Zanesville, Dr. J. G. F. Holston; Cannelville, Dr. G. B. Trout; Gloucester, Dr. A. J. Crawford.
The Plant system has also fitted up several hospital cars, which are scattered along the road at division points. In case of an accident one of these cars is dispatched to the scene at once, and the wounded are cared for properly and immediately. An operating room in the car is fitted with a glass-topped table and all the appliances for performing aseptic operations. There is a consultation room and a larger apartment, fitted with cots and hammocks, in which the injured may be conveyed safely and comfortably to the railway hospitals.
It is proposed to have these hospital cars so located that one can be sent to any point on the road within two hours. A supply of stretchers is carried on each of the hospital cars, on which the wounded may be removed from the wreck, and each car will have accommodations for more than a dozen sufferers. The intention of Dr. Frank H. Caldwell, the chief surgeon of the Plant system, is to use the hospital cars chiefly to transport the wounded to hospitals, and the operating-room will be used only when a delay would be dangerous to the patient.
The Association of Military Surgeons.
The sixth annual convention of the Association of Military Surgeons was held in Philadelphia, at the Broad Street Theater, May 12. Among the members of the association present are the following: Major Thomas J. Sullivan, Chicago; Major J. V. R. Hoff, Governor's Island, N. Y.; Major Thomas Rockwell, Rockville, Conn.; Colonel L. B. George Austin Bowman, Woodstock, Conn.; Almy, Norwich, Conn.; Brigadier-General Captain J. Pilcher, Columbus Barracks, Ohio; Major Samuel Q. Robinson, Fort Reno, Colo.; Major C. L. Seigman, Fort Adams, R. I.; Colonel C. C. Byrne, Governor's Island, N. Y.; Lieutenant-Colonel R. W. Blood, Boston, Mass.; Assistant Surgeon-General C. R. Alden, Washington, D. C.; Major L. C. Carr, Cincinnati, Ohio; Commodore Albert Gihon, New York; Major S. S. Tesson, Fort Ethan Allen, Vt.; Major V. Havard, David Island, N. Y., and Major George W. Adair, Washington Barracks, Washington, D. C.
A Case of Traumatic Ventral Hernia and one of Hæmophilia.
Mr. Garstang reports the following interesting cases in a recent number of the London Lancet:
Traumatic ventral hernia of the kind described in the first case is of very unusual occurrence-in fact, it has received little notice in our general text-books. Such a hernia, as the result of direct subcutaneous injury, may develop immediately in consequence of rupture of the muscles in the abdominal wall, the protrusion taking place through the opening made, or atrophy with resulting weakness may ensue at the point injured and a hernia develop secondarily. Examples of the former are given by Gay, Meckel and Bryant. The patient under the care of Gay had a blow from a buffer in the abdomen, and on dissection some of the viscera were under the skin and had come through a rent which divided the left rectus and left epigastric artery, the linea alba, and part of the right rectus. Included in the term traumatic, and much more common than those already referred to, are the hernia which protrude through the scar resulting from the wound made by a surgeon for the removal of an abdominal tumor or for the evacuation of an abscess, also wounds of the parietes received in other ways by stab or gunshot. We are still in a condition of uncertainty as to the exact deviation from the normal which produces hæmophilia, and the facts that are known about
it, such as its hereditary character, its more frequent appearance in the male, and also that it is congenital, do not help us in respect to the treatment of the hemorrhages which are so apt to prove fatal. It is probable that antiseptic treatment with pressure will do more for the arrest of hemorrhage in these cases than was formerly possible. When the wound suppurated and hemorrhage frequently recurred from it the attempt to apply pressure of the application of styptics only seemed to make the wound a larger one and the fever more intense. Of the numerous drugs which have been recommended for the treatment of the hemorrhages the only one which has seemed to us to exercise any control on the loss has been belladonna, applied externally in the event of large subcutaneous hemorrhages, or given internally in cases of bleedings from the mucuous surfaces. For the notes of the cases we are indebted to Dr. G. Wilkinson, late senior house surgeon.
Case I. A boy aged fifteen years was admitted to the Bolton Infirmary on February 7, 1895, with a swelling in the left hypochondriac region, the result of an injury. He gave the history that he was carrying a bundle of dyesticks, when he stumbled and fell with his abdomen on the blunt end of one of them. On admission there was found to be a swelling about the size and shape of half an orange, midway between the umbilicus and the cartilage of the tenth rib on the left side. When the patient coughed the swelling enlarged. It could be put back entirely into the abdominal cavity, and when this was done a well-defined rounded opening about one and a half inches in diameter could be felt in the abdominal wall beneath the skin. The substance protruded beneath the skin when the patient coughed and had the knotted feel of omentum. The skin over a part of the swelling was superficially abraded. The patient was put to bed, carefully dieted, and a pad and bandage were applied to the seat of injury. On March 6 the subcutaneous rent in the abdominal wall had nearly closed, so that only the tip of a finger could be introduced, and the abrasion had healed. The patient was supplied with an abdominal belt with pad and was allowed to get up. On December 9 the patient came up for inspection. He had resumed work and discontinued the use of the belt. There was a prominent scar marking the seat of abrasion, which showed signs of cheloid growth. The rent in the muscular layers had quite closed and firm scar tissue was felt.
Case 2. A boy aged eleven years was admitted on June 18, 1894, with hemorrhage from the cheek and gums. He gave the history that he was struck on the left cheek with a cricket bat four days before admission, and that there had been continual bleeding from his gums and
cheeks since. His previous history was as follows: When two years of age his tongue ulcerated and bled for three weeks; at three years of age he received a wound on the back of his head, which bled during five or six weeks; when seven or eight years of age he had a wound of the temple, which bled three of four weeks in spite of plugging, caustic, etc. There was no history of any male relative having been similarly affected. A sister aged twenty-five years had had four miscarriages and a boy who died at the age of eight months. The patient had a sallow complexion with transparent condition of skin. The conjunctiva was not unusually pale and there was no heart murmur. Tincture of perchloride of iron was applied to the wound of the cheek without much beneficial effect. Finally a silk suture was introduced and proved effectual. Arsenic and tincture of perchloride of iron were given internally and the mouth was frequently washed out with iced Condy's lotion. On July 9 the wound had quite healed. On November 28, 1895, the patient was re-admitted on account of hemorrhage from a wound of the upper lip inflicted by falling against a frame eight days previously. The hemorrhage having ceased after admission it was not thought advisable to disturb him. Free hemorrhage, however, came on in the night, which was controlled by the introduction of a silk suture. On December 23 the wound had not healed, but was slowly granulating.
PRACTICE FOR SALE:-I offer for sale my practice in the county seat of one of the best counties in Iowa. Have been here for twelve years; am surgeon of the leading road entering the town; am medical examiner for six life insurance companies, etc. I simply require that my successor buy my office fixtures.-mostly new-worth $700. Purchaser must be reliable physician with few years' practice. Address "Z. V.," care RAILWAY SURGEON, Chicago.
Desiring to remove to the Pacific Coast, I offer my well-established practice of over 20 years to any physician who will purchase my real estate, situated in one of the most beautiful and thriving towns in Southern Michigan, and surrounded by a very rich farming country. The town is intersected by two important railroads, for one of which the subscriber is surgeon. The real estate consists of a fine brick house of eight rooms and two fine offices besides, attached to, and a part of, the residence. A fine well of the purest water, two cisterns, waterworks, etc. Fine garden filled with choice fruit in bearing, peaches, pears and apricots and small fruits, raspberries, currants, etc. Fine barn and other outbuildings, comparatively new and in the very best condition, all offered with the practice and goodwill at a very low figure for cash. Address MACK, Surgeon," care RAILWAY SURGEON, Monadnock Block Chicago, Ill.
By reason of failing health, physician wishes to dispose of real estate and practice. Practice amounts to nearly $4,000 per year. No charges except for real estate. Address WM. D. B. AINEY, Montrose, Pa.
Desiring to remove to a warmer climate, owing to poor health. I offer my well-established practice of 11 years to any physician who will purchase my real estate; situated in one of the most thriving towns in the Platte Valley, in Central Nebraska, on main line of Union Pacific R. R., on which road I am the assistant surgeon.
The real estate consists of 2 lots "on corner," on which there is a fine artistic "modern" frame house, 8 rooms; stable 20x30, wind mill, tower and 30-barrel tank; nice blue grass lawn, trees and fine garden (all new); and all offered with my $5.000 practice and good will, at a very low figure. A part cash, balance on time. A very thickly populated country. Address 'BOVINE," care RAILWAY SURGEON, Monadnock Block, Chicago, Ill
SHOULDER INJURIES, WITH SPECIAL REFERENCE TO THEIR MORBID ANATOMY AND DIFFERENTIAL DIAGNOSIS.*
CONTENTS OF THIS NUMBER.
Shoulder Injuries, with Special Reference to their Morbid Anatomy and Differential Diagnosis-THOMAS H. MANLEY, M. D.... 49 You Have Symptoms of Immortality, or a Story of an Egomaniac-by W. B. O...... 59
CHICAGO, JUNE 30, 1896.
EXTRACTS AND ABSTRACTS:
67 Some Causes of a Nation's Depopulation. 67
Compound Fracture of Thyroid Cartilage 69 Spinal Surgery...... 69
The Duty Line in Medical Journalism... 70
Officers of the N. A. R. S., 1896-7.
.F. J. LUTZ, St. Louis, Mo. First Vice-President... W. R. HAMILTON, Pittsburgh, Pa. Second Vice President....J. H. LETCHER, Henderson, Ky. Third Vice-President......JOHN L. EDDY, Olean, N. Y. Fourth Vice-President....J. A. HUTCHINSON, Montreal, Canada Fifth Vice-President.. .A. C. WEDGE, Albert Lea, Minn. .RHETT GOODE, Mobile, Ala.
Seventh Vice-President... E. W. LEE, Omaha, Neb.
.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.
BY THOMAS H. MANLEY, M. D., NEW YORK.
The shoulder, because of its situation, its wide range of motion and, frequently a site exposed to considerable concussive force, often sustains various degrees of violence. An impression generally prevails, that the accurate detection of the various types of trauma borne by this region of the body, is ordinarily a simple matter. Applying this statement to the more ordinary injuries, it is probably correct; but, if it be intended to include all, it certainly is an error. My own fifteen years' experience in active hospital service, wherein, traumatism of every description constituted the larger number of cases, has convinced me, that, if perhaps we exclude the elbow, there is no joint in the body, in which the diagnosis of injuries of structures entering into, or contiguous with it, is more difficult to recognize. It may sound strange, but there can be little doubt, that there are not a few practitioners who, in the whole course of their career, have never detected some of them. Paradoxical as it may seem, but it is probably true, that some may have treated lesions, the actual existence of which they have been in ignorance of. On general principles, the case was dealt with; "palmed" off as a sprain or contusion, recovery of function returning in various degrees, not so much in consequence of treatment, but in spite of it.
Through an oversight of this kind, serious consequences may accrue to the patient; and its ultimate detection, by a more cautious, unskilled diagnostician, can only result in seri
*Read by title at the ninth annual convention of the National Association of Railway Surgeons.
ous damage to one's professional reputation, if not involve him in expensive litigation.
With a view especially, of endeavoring to throw some light on this feature of diagnosis, this brief review of the subject is undertaken; more so, inasmuch, as no text-book or other surgical work that the writer is familiar with, deals with it in detail, at this joint. The average work on bone and joint distraints, considers the subject in a manner too technical and artificial to be of much practical value, to those whose practice is exclusively surgical, or, even, the general practitioner, who frequently unaided, must promptly act and give relief to the injured.
CONFIGURATION AND FUNCTIONS.
The shoulders give lateral width, squareness and fullness to the upper segment of the trunk. Regularity in growth and development in this situation, impart that symmetry and perfection of outline, so essential to ideality of
The shoulders, suddenly thrown inward on the body, afford great protection to the upper segment of the thorax. This provision of the economy will largely explain, why, after contusive injuries, we so seldom meet with costal fracture, above the nipple line, or the most vital region of the thorax.
Of all the articulations or joints, in the human body, the shoulder is not only the most complex, but the most perfect and powerful compound articulation, as well, considering its structural composition.
Shoulder motion or movement, involves something more than one articulation, as one might infer, by a superficial examination of the anatomy of this region.
To speak of the shoulder-joint, especially, when function is referred to, is inaccurate, and has so often led to such mistaken inferOences, as to betray the unwary into erroneous conclusions, both in the recognition and treatment & injuftes, over this area of the body. Full exercise of houlder motion, always in
Some authors imply an analogy between the volves two articulations, at least. It is thereshoulder and the hip, but, on close inspection, with an analysis of structure and function, this seems very remote, if it exist at all.
The shoulder is made up of a bony framework, with two joints, and a large muscular development, resting on the lateral wall of the thorax, and swung by muscles upon the spine, and only steadied in position, by the clavicle. With their appendages, the arms, forearms and hands, their purposes being solely for prehension, and the performance of the mechanical needs of the body. The shoulders, because of their position and mobility, afford shelter and protection to the contents of the chest or thorax, and in the application of great violence, to the lateral surfaces of the body, receive the primary impact, and so diffuse or moderate it, as to often guard the skull, the spine or thorax, from serious damage. A young lady lately came under my observation, who sustained a fracture in the upper dorsal segment of the spine, from a fall of less than three feet, from a hammock, striking squarely on her back. The consequences to the spinal functions have been most disastrous. The same degree of force, sustained by the shoulder, would probably have resulted in nothing more, than a severe contusion, or, at most, a clavicular fracture or dislocation.
fore highly proper and equally necessary, that we should speak rather of shoulder-joints, than a shoulder-joint; and let us hope, that in the near future, some rising anatomist, with a greater regard for a full and truthful description of structure and function, than a puerile submission to the tyranny of tradition, will come out, with such an account of this important structure, as will give to the subject such interest and practical value, as never yet has been bestowed on it.
The upper extremity is brought into immediate relation with the body or trunk, through that limited, flat articular surface, connecting above, the shoulder-blade with the collar-bone; the power, being linked with the brachial lever, through the medium of another articulation, which imparts to the arm, a great diversity of motion. Several large nerve cords pass down through the osseo-muscular structure of the shoulder, anteriorly and internally, to reach the axillary pit. Following along the same path are the two great vascular trunks of the arm. These important structures, though well fortified against exposure or injury, by a provision of the economy, yet, in the event of serious disorganization or displacement, of the osseous framework of the shoulder, can scarcely escape damage.