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cally, I believe that the time is not far distant when the medical practitioners of this country will give greater weight and thought and consideration to asepsis than to that of antisepsis. It is only a question of a short time.
Dr. Summers: I wish to state in a word or two that aside from antisepsis and asepsis, the central idea or keynote of the whole thing lies in leucocytosis, and as one gentleman very tersely added, phagocytosis.
Dr. H. H. Mudd: For two years, practically, I have not used iodoform. I have not used any of the medicated gauzes, and I use only pure solutions of water, sometimes salt solution, but mostly distilled water, about wounds. I have had more satisfaction in the last two years' work than I have ever had under other plans of antisepsis. I do not wish to discourage the latter, because I think it has a purpose. Its greatest purpose with me is in making myself clean, in making my hands and the surface upon which I work clean, as well as wounds and the patients themselves clean. It does not help in the healing of wounds.
surface, without attempting sterilization, and got the desired result.
Dr. Lee, Omaha: In regard to iodoform, I would ask one question of those who do not believe in its antiseptic or germicidal effect. Our experience teaches us that sterilized iodoform oil injected into a tubercular joint, has the effect of destroying the tubercle bacilli, and if it destroys the tubercle bacilli, surely it is a germicide and acts as such when used externally.
Dr. Lane, Kansas: It does not necessarily follow that iodoform is a germicide because the bacillus of tuberculosis disappears from the knee joint when the iodoform is injected into it. It is probably settled that germs do not develop well in the presence of iodoform. It is not very irritating to granulation tissue. It should be sterilized before it is used. It is made to do too much work. It takes very little labor to employ antiseptics; it means much labor and much pains to use asepsis. I believe the physicians present would have little use for antiseptics if they were satisfied they had a condition of asepsis. The blood is an antiseptic agent. I used it freely antiseptic agent. Germs inoculated on a mucous membrane will be destroyed by nature's process without antiseptics sooner than if they were used. I believe we are learning to find in nature an antiseptic; to find in the tissues of the body an antiseptic. We are extracting it from the horse and expect much from serum. I agree with Dr. Mudd that antiseptics are good for the physician and asepsis for the pa
I should like to add a strong word of caution against the use of iodoform. I used it freely for a number of years. I used it also in the abdominal cavity on the peritoneal surfaces, and I found that I caused trouble not infrequently with my patient from what I supposed to be shock from the operation. I am happy to say that a large number of those cases of shock, that I had supposed to be such, have disappeared under the use of simple sterilized There is another point connected with iodoform dressings within the peritoneal cavity, and that is this: By its absorption you not infrequently obtain or bring about a disturbed action of the kidney, and I believe this disturbed action of the kidney follows the use of iodoform. It is a dangerous agent to use in the abdominal cavity. It is a comparatively easy matter to sterilize your dressings; it requires a little preparation, you are more thorough and more certain of your bandages, if you make the sterilization yourselves.
Dr. E. R. Lewis: I want to make a remark about hair bulbs. I caught the idea from Dr. Outten. In an extensive nephrectomy case the wound was a long time in granulating, and I removed a hair from the head of the patient, three-quarters of an inch in length, then dropping it onto the granulating
President Murphy: If there is any one thing for which the medical profession is noted, it is its unanimity, the way in which it agrees upon all things. There is not one dividing or opposing element in this discussion. You are one, but you are attacking this subject from different standpoints. Dr. Outten, who prepares his hand properly, who devotes time and attention to his garments, who has everything strictly clean surrounding his patients, does not need antiseptics. What for? Nothing to kill. He does not need his gun. That is the only difference. The other man who has not had the training in preparing his hands, who does not understand how to cleanse himself for an operation, needs his carbolic acid and his bichloride.
Again, as regards the hair, taking it and put
THE CHIEF SURGEON, MO. PAC. RY., IN HIS OFFICE.
the wound. Granulations are a protection to it, except against certain microphytes. They afford no protection whatever against the streptococcus erysipelatosus. This germ destroys the granulations. They melt before it just like snow melts before the sun. I cannot let iodoform be abused in this way and sleep well. It is used in joints in the abdomen, and it is also misused in joints and misused in the abdomen. It is used properly and improperly upon the surfaces of wounds. There are undoubtedly present in this hall, gentlemen who remember the teaching of the late Professor Allen. Asked what he
would do in a case of scarlet fever, he
said, "Gentlemen, that depends upon what is the matter." It depends upon the condition of the wound whether you use iodoform or not. It depends. upon the condition of the joint whether it is necessary to put iodoform in there or not. But if you put idodoform in, for the purpose of killing the microphyte, or strangling him, it has no such effect, but it has the effect of stimulating the reproductive power of the tissues of the part, and that overcomes the destructive effect of the microphytes. Will you use iodoform on the surface? Yes, in certain kinds of wounds you use it on the surface, but not in all. Will you use this or that application? That depends upon what is the matter. Now, gentlemen, we are a unit on this subject. One man has to treat a certain class of cases and gets good results by his method;
another treats a different class of cases, and also obtains equally successful results by his plan, and the consequence is one thinks his method to be a good deal better than the other. You are accomplish
THE MISSOURI PACIFIC HOSPITAL
The Missouri Pacific Railway system, consisting of the Missouri Pacific Railway, with its leased and operated lines, has a total of 1,773 miles of track in operation in Missouri, Arkansas, Louisiana, Kansas, Nebraska and Colorado, and gives employment to about 18,000 men. With such a force it is not necessary to say that the road has use for a surgical system, and it has The chief surgeon*
THE MISSOURI PACIFIC HOSPITAL AT ST. LOUIS.
ing the same results in different ways. an admirable (Applause.)
Dr. Outten: I do not want to weary you with extended remarks at this time. All I have to say is this, that it is useless for me to attempt to defend asepsis, because the triumphs of surgery for the last ten years have come entirely from this direction. While I used to think of Sir Joseph Lister as the ideal man, I likewise
used to have a certain species of contempt for Lawson Tait. But I am free to confess that Sir Joseph was the eramaker, and I likewise know that Lawson Tait was the interpreter of what had come before, and his results far surpass those obtained on the lines
is Dr. W. B. Outten of St. Louis, to whose high executive skill has been due the efficiency of its hospital service since its inception. The road has a staff of eighty surgeons, under Dr. Outten, in various towns on its route, with hospitals in St. Louis, Kansas City and Little Rock. The hospital system was established in May, 1884, by the
enunciated by Sir Joseph Lister. I thank you for your discussion of my paper.
Members should begin at once and arrange for their transportation to Chicago for the convention in plenty of time.
opening of the St. Louis hospital, with a bed capacity of 62 beds, which has been increased until it is now 130, and under pressure will accommodate 155. The St. Louis
*This article is published in the Railway Surgeon clandestinely and without having been read by the editor-in-chief.-Sub Ed.
tions filled for in and out patients, and sent out on the road to such employes as made request.
During the year, 1,146 patients were treated by specialists; 5,168 visits were made to them, and 209 operations performed. An average of over 11,000 meals are supplied monthly. A monthly report is issued, giving an exhibit under the following heads:
Patients on hand.
Number of deaths.
Total number treated during month.
Number of patients treated during month.
A regular report is made of the dispensing department and reports of the laundry, meals, ambulance and administration. A table is given, showing the age, nativity and occupation of patients and a classified, tabulated statement giving, under special heads, the various diseases. These statistics are very complete. The chief surgeon has records covering 270,000 medical and 30,000 surgical cases. For the past five years the St. Louis hospital of the Missouri Pacific railway has treated an average of 15,000 cases annually, and it seems the limit has not yet been reached. It has demonstrated its usefulness in many directions. All kinds of cases are treated, except contagious diseases and those arising from immoral acts. The hospital service also cares for the health of the employes in a sanitary
Rules are issued for their guidance, concerning their habits, vaccination and everything tending to prevent sickness.
In all ways the policy of the management is broad-gauge and liberal. No effort is made to economize in any matter wherein the welfare of a patient is concerned. The sole aim appears to be to give the best possible care to every individual case, and to have the entire system of the road so well in hand that everything and everybody work together to the best advantage.
There is little to be said in explanation of our illustrations, which are made from photographs taken especially for this article by a representative of The Railway Surgeon. To nearly all members of the National Association the figure of the surgeon-in-chief will be pleasingly familiar. There is no man in the
country to whom railway surgery owes as much as it does to Dr. Outten. F. S. D.
Fracture with Dislocation of Humerus Treated by Arthrotomy.
At a recent meeting of the New York Surgical Society Dr. W. T. Bull presented a patient, a boy, aged fifteen years, who was admitted to the New York Hospital, April 10, 1896, shortly after having been knocked down and striking on his right hand and elbow. The right shoulder was much swollen, the deltoid rigid, the arm, from acromion to left epicondyle, shorter by three-quarters of an inch than the other. There was a soft crepitus on rotation, and the head could be felt immovable in the axilla.
Forty-eight hours after admission, under ether, futile efforts were made by manipulation and direct pressure to replace the head. A longitudinal incision was made through the fibers of deltoid just internal to acromion, exposing the seat of fracture and capsule of the joint. The upper epiphysis, consisting of the head and two tuberosities, was separated from the shaft, but held in close contact by peritoneum and fascia. The head was fully in the axilla, and there was no displacement relative to the shaft. After division of the capsule the head was drilled, McBurney's hook inserted, and traction was made with pressure on the head. This failing to move the head, wider division of the capsule was made, and then the head was pried into place with a periosteal retractor.
The anterior or outer part of the wound was closed over an iodoform tampon which rested on the head of humerus, and a second one was placed in a counter opening posteriorly, also leading to within the capsule. Plaster-of-paris bandage. There was a moderate wound reaction, but no profuse suppuration. In two months the wounds were superficial and motion improving. In two and a half months all wounds were healed.
The splint was used for eight weeks. At the end of eight months (December 9, 1896) it is found that the boy has for practical purposes good use of the arm and hand. There is no shortening nor atrophy, though just below the acromion the fullness of the deltoid is less marked than on the other side. Moderate stiffness, while the head of the bone is clearly in place. Rotation possible to about one-half its normal extent. Abducton about three-quarters of the way to the right angle. (horizontal position). The movements of the scapula complete a range of motion but a trifle short of that possible on the sound side. -Annals of Surgery.