may produce diseases in the spinal cord after the manner in which joints are involved. Dickinson writes: "Myelitis after gonorrhea is a sequence which may be considered to be beyond doubt; and it is at least probable that a similar result may now and then ensue after other kinds of suppurative diseases." The more recent advance in our knowledge of septic diseases lends much support to this conclusion. In cases of this origin the prognosis is far better. As a rule, the chances of recovery are very poor, nearly all cases dying within a few weeks, or months, at most. I recall a patient under my observation at the Monroe County Poor House, who was sent there with the diagnosis of locomotor ataxia. This man had acute myelitis and died in four weeks. found retention of the urine to the amount of eight quarts. He had paraplegia, which condition was followed by bedsores in three to four days. In this case the disease was supposed to have been caused by exposure.

I

The diagnosis of myelitis as a rule does not offer much difficulty. The usual sudden onset of the paralysis, the absence of contractions, the disappearance of the reflexes, and the band-like constriction are usually sufficient to make the diagnosis. We may also have incontinence of urine and fæces, and bedsores are quite likely to occur. We may not, at all times, find this complete array of symptoms. The location of the disease and its extent will often vary the symptomatic manifestations; but, gentlemen, it is the unexpected which is likely to occur. Our patient has practically recovered, and has kindly consented to present himself for our inspection. He is not perfectly well, and yet I think you will agree with me that he is a pretty lively dead man. You will notice that the reflexes are absent and his gait is peculiar. His urine is free from pus and albumin, and there are no bladder symptoms. There is, however, yet considerable anæsthesia of the extremities. These symptoms, he says, are gradually improving.

Speaking briefly as to the pathology of myelitis, if the cord be exposed there may be found the results of inflammatory action, such as injected areas, alteration of the gray substance with more or less effusion. In some cases no change can be noticed microscopically; yet the microscope will probably never fail to show some lesions. The nerve tubes will be swollen, tortuous and broken; the axis cylinders will have their places taken by oil globules; pus corpuscles may or may not be seen. The fact that in many cases no lesion has been thought to have existed has given origin to a so-called reflex paraplegia, but year after year we find the functional diseases decreasing. Pathological researches are constantly bringing into view structural

alterations. So, in myelitis, as in other spinal diseases, we shall find the results of pathologically morbid processes. If the alteration in the spinal cord has gone beyond a certain degree, we cannot reasonably expect regeneration and consequent restoration of functions. Still there are those who believe that in lesions of some magnitude, involving the cord, recovery may occur with more or less perfect restoration. It will not, of course, be inferred that we consider that there is any direct communication between the spinal cord and this man's seat of suppurative disease. The irritation resulting in the spinal lesion may have been simply a metastatsis, a chance bacterial infection; or it may have been the manifestation of some poisonous toxin, in which case the medium by which the bacteria or toxin was conveyed could have hardly been other than the blood. There is, however, another possibility in the case, and that is the direct nervous influence of a disease in close proximity to the spinal cord. Physiological researches have demonstrated the possibility of inflammation being produced by constant or oft-repeated nervous shocks or irritation applied to the cord.

As to treatment, I may say that patient was given nearly all the remedies recommended for this disease. Early I ordered wet cups to the spine, and in due course he was given belladonna, ergot, bromide and iodide of potassium. I question the propriety of making strong counter-irritations, or applving intense cold over the spine in myelitis. Every effort should be made to conserve the vitality of the skin where the tendency is so great to the formation of bedsores. After the active symptoms began to subside, strychnine and iron were given, and thorough rubbing of the extremities every day was ordered. As the improvement became more manifest, I used the Faradic current with seemingly great benefit in restoring the atrophied muscles. The pyelitis was treated mainly by the balsamic preparations, sodium benzoate, tincture chloride of iron, pichi, etc. The one remedy which I found most efficient was the oil of sandal wood. I would gladly have gone more into details save for the fear of becoming tiresome. trust the discussion will bring out many points that I have omitted to mention.-Physician and Surgeon.

The Medical Profession in France.

Miscellany.

Suit for Damages for Ante-Natal Injuries.

It is stated in the Medical Standard that a suit has been instituted against St. Luke's Hospital of Chicago, by Thomas Edwin Allaire, through his mother, which is reported to be the first case of its nature in this country. In February, 1886, three days before the birth of the plaintiff, his mother, Ada A. Allaire, was injured in an elevator at the hospital. When the plaintiff was born it was found that his left leg was drawn and the muscles were contracted. The limb is three inches shorter than the other one, and he will be always lame. For these injuries received before his birth the youth wants $50,000 damages.

Cause of Untoward Effects Ascribed to X-Rays.

Dr. Howard Lilienthal of New York, writing to the editor of the Medical Record, says: It has been my fortune to observe certain cases of dermatitis, loss of hair, etc., in patients who have been exposed to the action of X-rays. Numerous other instances of burning, depilation and bleaching have been reported by different observers. These annoying and unlooked-for accidents tend to lessen the frequency of resort to a method of investigation which I believe to be too valuable to be thus limited. Let me, therefore, call attention to what Mr. Tesla has said in a recent number of the Electrical Review. He believes the evil effects are not due to the X-ray itself, but to the incidental formation of ozone. Since the appearance of the contribution to the Review, he has kindly expressed himself further on the subject to the writer. He says in a recent letter: "Since I made those statements (in the Electrical Review) I have gained additional evidence that the X-rays themselves are incapable of producing the actions reported, and that they are due to ozone and possibly nitrous acid. I wish to add that also heat may be to a certain extent responsible." He goes on to state that the effects always follow long exposures at short range, and he believes that the long-continued heat may cause desiccation of the skin, with subsequent dermatitis. As to avoiding the chemical effects, Mr. Tesla goes on to say: "I have suggested a remedy, consisting in static screening of the person in any way. The most perfect way is to make a conducting enclosure of wire or thin sheets, and connect the latter to the ground. The person should then be in that chamber, and the bulb outside of it." He goes on to say that in his experience this method will guard against ill effects. Alumi-num, which is transparent to X-rays but which

will not allow chemical substances to pass, might be used to make the screen.

Mr. Tesla attributes most of the reported accidents to the use of insufficient instruments, necessitating too close and too long exposures.

The writer, in confirmation of Mr. Tesla, desires to call attention to the occasional occurrence of bleaching, which is a characteristic effect of ozone.

Bullets in the Brain and the Rontgen Rays.

A. Eulenburg (Deut. Med. Woch., August 17, 1896) relates to cases in which it was possible to localize bullets in the intra-cranial cavity by means of the X-rays.

Case I. A man, aged 18, accidentally shot himself in the head with a revolver. The bullet entered 3 centimeters above and 2 centimeters in front of the attachment of the ear. There was complete unconsciousness until the following morning. On the third day a leftsided homonymous hemianopsia developed, and then a left hemiplegia. The bladder was temporarily paralyzed. The hemianopsia disappeared on the tenth day, and the hemiplegia gradually got better, with the exception of the lower part of the leg. The patient was lame, but could walk. At the end of the seventh week Eulenburg found the lower face muscles weaker on the left side than on the right, and also the left arm weaker than the right. The gait was faltering, and the left leg stiff. Movements of the foot and lower leg were only just possible. Sensation was considerably affected. There was pain in the back of the head. Progressive improvement ensued. Eulenburg thought that the bullet had penetrated to the right of the sella turcica, injuring the right optic tract and the right crus. By radiography Buka showed that the ball was in the middle fossa of the skull to the right of the middle line.

When

Case II. A man, aged 33, attempted suicide ten years ago. The revolver wound was in the hinder part of the right temporal region. At first there were signs of intra-cranial pressure. For the first four years only slight symptoms were noted. Attacks of pain in the head supervened, and the patient thought that the bullet must still be present. He was then in an asylum for five years, and discharged as incurable. After his discharge he seems to have been able to work. seen by Eulenburg the man was pale and wasted. Hardly a trace of bodily or mental symptoms could be made out. There was occasional headache in the right supra-orbital and temporal regions. There was thus no clinical evidence that the bullet was still present. It was, however, shown by Buka, by means of the Roentgen rays, that the bullet was situated in the middle fossa of the skull behind the right orbital fissure.

Brissaud and Londe (Sem. Med., June 24.

1896) report a case in which a man had been struck by a revolver bullet (caliber 7 millimeters) in the middle of the left frontal eminence on August 4, 1895. Various symptoms followed, and finally a spasmodic left hemiplegia of both limbs and the face remained. The upper fibers of the facial, the motor oculi, and the masseteric nerves were not involved. The Roentgen rays showed the outline of the skull, the fronal eminence and sinus, the maxillary sinus, petrous and malar bones, zygoma, orbital cavity, etc. The bullet was seen situated in the posterior region at the level of the second temporal convolution, probably above the tentorium. This position corresponded exactly with the direction of the track deduced by the resulting paralyses. The chief interest, besides the exact localization of the missile, consists in the fact that the bullet, being in the temporal region could not be the cause of the hemiplegia. The latter was due to the section of fibers met with by the bullet -that is, it had a capsular, not cortical, origin, and therefore could not have been benefited by any operation. An exposure of an hour and three-fourths was given, and the image would have been still clearer but for a slight clonic movement of the head.-British Medical Journal.

A Wonderful Escape.

The Lancet is responsible for the following account of an almost incredible escape: "William H. Bartlett, aged 18 years, a few days ago fell down the shaft of North Biddick pit, in the county of Durham, a distance of 270 feet, into some 13 feet of water, and upon being rescued was found to have sustained trifling injuries both wrists sprained, and a few scalp wounds."

The Drainage of Wounds.

Maj. Charles Adams (the Medical Standard, December, 1896) considers that drainage must be employed when there is free pus in the tissues or cavities; in all infected wounds; all wounds that have been infected by chemical irrigation; all wounds whose surfaces have been devitalized by traumatism, operative or otherwise; wounds in the very thick adipose tissue, the oil poured out in such incisions being inimical to healing; amputation wounds, in which the flaps are thin; wounds of the neck wherein extensive connective tissue planes are opened; penetrating and perforating wounds of the brain; all closed wounds whose surfaces cannot be approximated accurately by suture or compression (cases in which under absolute asepsis we expect filling of cavities by blood clot.) Drainage should be also

employed in cholecystotomy (tubular drainage of the gall bladder); in operations on the common duct (tubular drainage surrounded by gauze packing); operations upon pancreatic cysts (tubular drainage after attachment of cyst to anterior abdominal wall); hydronephrosis and pyonephrosis (lumbar tubular drainage); tuberculous ascites (tubular and gauze drainage combined); all cases of abscess involving any part of the peritoneum in its wall (tubular drainage); all cases of operation upon the peritoneal cavity, when copious serous effusion is to be expected.

Dermatitis Caused by Roentgen Rays.

Henry C. Drury (British Medical Journal, November 7, 1896) reports the case of a man, aged thirty-five years, on whom an attempt was made to get a Röntgen photograph of the renal region. The exposure lasted one hour. Three hours later he felt nausea, which, however, passed off. Six days later another attempt was made, this time the exposure being with a somewhat stronger battery for an hour and a half. After the patient left the laboratory he again felt nauseated, and had to take some brandy before reaching home. Next day the abdomen was slightly red; there was no itching or pain. On the third day redness was more intense. On the fourth day vesicles appeared; these increased in size and number, ran together, broke, and formed eighteen days after the second exposure a patch seven and a half by eight and a quarter inches. It looked like an irritative eczema, with exfoliated epidermis and a profuse sero-purulent discharge. Sixteen weeks after the second exposure the sore was three by three and a half inches and covered with a thick leathery insensitive false membrane. The patient improved somewhat later, but at date of writing was still unwell.

Asepsis and Gallantry.

The Hungarian government, says the New York Medical Record, permits women to study medicine if they so desire, but one of the professors at the University of Budapest has recently proclaimed that he has something to say in the matter. Of the five women now studying medicine there, one has a remarkably fine head of hair, which the professor of surgery says must come off before she can be permitted to attend his clinics. The reason he gives for his prohibition is that "wool carries infection."

WANTED-We will pay 20 cents for a copy of The Railway Surgeon of Vol. III, No. 18, date January 26, 1897. Address The Railway Surgeon, Monadnock block, Chicago.

Of all the lesions that come under the care of the railway surgeon injuries of the hand, including the fingers, are by far the most frequent. Indeed, a very large proportion of railway employes, particularly those engaged in train service, will be found to have sustained injuries of this character. We are not here to inquire the cause. That is not as surgeons, our province; we are content to know that the condition exists.

To classify these lesions would be an almost hopeless task, so protean are their aspects. One thing, however, must be borne in mind; apparently severe injuries do not always produce the most serious results, and vice versa. Allow me to say also, and say most emphatically, that nowhere in the whole domain" of railway surgery is conservatism strenously demanded than in these injuries. The knife, as far as possible, should be the exception, and not the rule, in these cases.

more

Prothetical mechanics, with all its ingenuity fails, and perhaps always will fail, to produce a competent substitute for the human hand, with its wonderful prehensile faculty. It, therefore, becomes our bounden duty to make a determined and persistent effort to save any portion of a hand, finger or thumb, remembering, that in no other portions of the body are reparative processes so prompt and certain; except, perhaps, in the tissues of the scalp and face. It is wonderful what strength and mobility these fragmentary hands and fingers. will develop, and their usefulness and value. I recall the case of a brakeman who had lost the whole radial border of the hand, including

* Read at the fourth annual meeting of the C., M. & St. P. Railway Surgeon's Association, at Chicago, November, 1896.

No. 23.

the fourth and fifth metacarpal bones; the third and fourth fingers entire, nearly the whole of the first and second nngers, and the second phalanx of the thumb. I succeeded in saving stubs of the fore and second fingers and what was left of the thumb of this right hand. By the aid of these three stubs, he writes, feeds himself, and does many other things much better than he could with any

artificial substitute.

Antisepsis has done much to assist us in this good work of conservatism in these injuries, but I appreciate as fully as anyone the difficulties that beset the path of the railway surgeon in attempting to secure antisepsis, more especially in injuries of the hand and fingers. This should only cause us to redouble our efforts to secure the desired end. In regard to antiseptics in these cases, I say candidly, after using, and seeing it used more than 25 years, I do not like carbolic acid. For the preliminary cleansing I use soap and water as hot as can be borne; water that has been boiled and allowed to cool; followed by a weak solution of lysol, with ether or turpentine, when required to remove oil or grease. Then a weak solution of bichloride of mercury or a saturated solution of boric acid. If a moist dressing is desired afterward I continue the boric acid solution. If a dry dressing I use equal parts of boric acid and acetanilid triturated into a fine powder. The dressings should be loose and the hand, for obvious reasons, kept elevated as much as possible. The laity have acquired an idea that carbolic acid. is an antiseptic, and we frequently meet cases treated by them on the principle that if a weak solution is good a stronger is better, many times with disastrous results.

A practitioner, in an adjoining town, prescribed a 25 per cent. solution of impure carbolic acid in linseed oil for a comparatively trivial contusion of the finger. The result

may be imagined. After 48 hours' of this application all efforts to save the finger were fruitless, and I was compelled to amputate. In many injuries of the fingers all that is needed is to "snip off" with suitable forceps the protruding bone, leaving the soft parts alone. A majority of these cases will be found to do better under this treatment than if a systematic amputation is performed. You are more likely to avoid "clubbing" and to preserve a more sightly finger tip. To avoid clubbing, if possible, use integument instead of muscle, from the palmar surface. If compelled to amputate above the middle of the second phalanx stitch the ends of the flexor tendons to the periosteum; otherwise there will be a tendency of the remaining portion of the finger to flex backward, and its use by the patient will be hampered and limited.

Injuries to the palm of the hand, not seriously involving the fingers, do not always demand amputation, depending largely on how far the blood supply to the fingers has been interfered with. If there is the slightest possibility that the hand can be saved, after the most thorough possible disinfection, let our motto be: Wait, for success will ofttimes crown our patient delay.

I recall a case where the whole hand except the thumb, fore and middle fingers, and including the ring and fourth fingers, seemed ground to a pulp. The fragments of the metacarpal bones were removed and a warm antiseptic solution applied. Death of the ring and little fingers subsequently ensued, and they had to be removed with their metacarpophalangeal articulations, and a portion of the ulnar border of the hand. Otherwise the patient did well, and has as useful, though perhaps not as ornamental an extremity as could be expected under the circumstances. I may also say that the habits and physical condition of the patient, on account of his intemperance, was decidedly against his recovery. I neglected to state that I have almost discarded iodoform as a dressing. Patients complain bitterly of its odor, and I do not blame them, and I am satisfied it possesses no superiority over many other less malodorous antiseptics. While engaged in writing this paper, I have read with much interest an article by Dr. Bouffleur, in the "Chicago Clinical Review," which illustrates, collaterally,

the utility of a judicious conservation in many cases of railway surgery. One case in particular which he notes, and wherein in my opinion, amputation would have been certainly fatal, the patient owes his life and limb to the exercise of prudence, caution and antiseptic treatment. Thirty years ago that patient would have been inevitably doomed.

In conclusion let me ask the gentlemen present to give us their views and experience in injuries of this character and freely criticize anything I have said. Gentlemen, give us your experience; one grain of it is worth pounds of theory. As I have said before, I for one, am here to learn; and while willing to contribute my individual mite, I come to hear rather than to be heard.

DISCUSSION OF DR. PLUMBE'S PAPER.

Dr. T. C. Clark: I recall a case of injury to the right hand in a young man who was greasing a gang saw and caught his hand in the cogs. In this case the metacarpal bone of the middle finger was broken in the middle; the finger itself was fractured in three places and nearly severed and it was ground full of grease; the wound was saturated and impregnated with it. I removed the finger and cleaned out the wound thoroughly and dressed it with a bichloride solution, and put on a splint to secure the metacarpal bone; there was a slight oozing from the wound. I removed the splint in four days and the man had the use of his hand. The occupation of the individual has a good deal to do with the surgery and also the portion of the hand injured has a good deal to do with it. The first joint of the forefinger is worth more than the whole of a man's little finger, and one joint of the thumb is worth more to a man in some occupations than the little finger or ring finger. It would be safe to say that the thumb and forefinger are worth more than any other portion of the hand, and every inch or half-inch or quarter of an inch we save is of inestimable benefit to a laboring man, and bears the same relation to the hand that the big toe does to the foot. Saving the big toe means saving the support of the foot. In any injury to the palm of the hand threatening suppuration early incisions should be made. Waiting is liable to be followed by disastrous results.

Dr. Binnie: I think all these papers are in the right direction and I do not desire to criti