A New Dressing for Fracture of the Clavicle.

Dr. M. L. Harris, in the Chicago Medical Recorder for September, 1896, describes a new dressing for fracture of the clavicle. A piece of ordinary roller bandage five or six feet in

INTERIOR OF A WARD, MISSOURI PACIFIC HOSPITAL.

length is laid over one shoulder like a suspender. The chest is then encircled by a roller three or four inches in width by eight or ten yards in length; this should be quite firmly applied, so it will not slip. A piece of muslin about three yards in length, and in width equal to the length of the arm from the axillary fold to the bend of the elbow, is folded in the middle, and, beginning at the ends, torn down the center to within about two inches of the fold. This makes a four-tailed bandage of the required width folded in the middle. The arm is passed through the fold so that the untorn portion comes opposite the outer surface of the humerus. All four tails pass behind and around the body in the same direction. By drawing on these the arm is carried backward and inward, the scapula upward and inward toward the vertebral column, while the tip of the shoulder and consequently the outer fragment of the clavicle are carried upward, outward and backward into place. The extent to which the arm should be drawn backward and inward depends entirely on the amount of displacement and deformity to be overcome. The object of tearing the piece into four tails is now readily seen. When the arm is drawn backward in this manner the anterior and outer surfaces are obliquely placed, so that were the bandage in one piece when drawn taut it would be making pressure at its upper edge, while its lower edge would be very loose. In passing the four tails around the body, they cross so that the two upper become the lower and the two lower the upper. In this way the entire width of the bandage is tight, so that the pressure is uniformly distributed throughout the whole length of the arm. The pressure com

arm, no matter how firmly it is drawn it cannot materially interfere with the circulation. The four tails are continued around the body as far as they will go, and pinned to the first roller.

A roller is now firmly applied around the body and arm together, and two large safetypins are placed just in front of the arm, passing through all layers of bandage, including the first body-roller. The loose ends of the first strip, or suspender, laid over the shoulder, are now passed over the opposite shoulder and pinned or tied, when the dressing is complete. It is not the intention that the suspender should offer pressure at the seat of the fracture, and should it do so the ends should be carried back over the same or well shoulder and tied. The sole object of the suspender is to prevent the dressing from slipping downward, owing to the tapering of the chest and body toward the waist. The object of the first roller about the body is simply to supply something to pin to; consequently, if it be insufficient in length or loosely applied, it will slip, thus allowing the entire dressing to become loose and inefficient. When convenient, this part of the dressing may be advantageously replaced by a piece of adhesive plaster four to six inches in width and long enough to encircle the chest. Standing in front, it should be applied from the patient's left to right in fracture of the left clavicle, and from right to left in right-sided cases. The posterior end of the plaster should be folded upon itself for about two inches, so as to leave a free end which will not adhere. This free end should come about opposite the anterior

ing, as the comfort of the patient dictates. Motion at the elbow cannot be communicated to the clavicle or. shoulder, for the shoulder in this dressing is absolutely fixed. Should the forearm show any tendency to swell, at it may occasionally if the four-tailed piece is a little too wide, so as to encroach on the superficial veins at the bend of the elbow, this may readily be prevented by the application of a light roller.

In view of the large number of dressings and appliances which have been devised for this very common fracture, a new one must needs possess some advantages in order to secure for it special consideration. The dressing is simple and easy of application; it absolutely fixes the arm and shoulder in the position which most perfectly reduces the deformity in the large majority of fractures of this bone; and it is comfortable. Dr. Harris has never had a patient express the slightest uneasiness while wearing it, which is in marked contrast to the discomfort of many dressings, some of which are almost unbearable. The seat of the fracture is at all times exposed to view, where it can be inspected at will without displacing or removing the dressings. The forearm and hands are perfectly free and can be used at the patient's pleasure, thus avoiding disuse atrophy and stiff joints from confinement.-Medicine.

Safeguards in Chloroform Administration.

W. J. J. Arnold, B. A., M. B., surgeon to the Cottage Hospital, Aberdare, writes as follows to the British Medical Journal: The capital fault in the ordinary method of giving chloroform is the absolute want of control on the part of the administrator over the quantity that the patient may inhale with each inspiration. It is common to find a great variation in the depth of the respirations taken by the patient during the time that he is going under, and whilst respiration is more or less within his own control, a number of very shallow inspirations being followed quickly by several very deep inspirations, whereby he may inhale a quantity sufficient to paralyze his respiratory center. I believe that this is the explanation of most of the deaths which occur before the patient has ever been properly under the anesthetic. The same danger arises at another stage in the administration, namely, when the patient is threatening to return to consciousnes after he has been anesthetized. The towel saturated with vapor is quickly reapplied, and the patient, with a few deep, gasping inspirations, inhales a quantity of chloroform for which his respiratory centers are quite unprepared, and cessation of function is too often the consequence. This danger can be entirely obviated by the intelligent use of an inhaler which accurately regulates the quantity

supplied to the patient during any inspiration. I say the "intelligent use," for the same danger is present if chloroform be recklessly pumped through an inhaler as when it is given unmeasured on a towel, though to a less extent. The secret of its safe administration lies in attention to two points:

1. A very gradual increase in the quantity supplied to the patient whilst putting him under. If this be carefully graduated so that the quantity of vapor reaches the maximum by almost imperceptible degrees, the two disagreeable and dangerous symptoms (struggling and vomiting) are almost invariably done away with. This is attained by attending to the amount of compression given to the bulb. At the start, during several respirations, only the slightest compression is used. A slightly deeper compression of the bulb is made for several ensuing respirations, and so on until a full compression is reached, which is kept up till the reflexes are abolished.

2. Once the patient is under, the amount must be reduced to the minimum, or something approaching it, and by continuing to supply him constantly with this minimum dose complete anæsthesia may be maintained continuously for hours with perfect safety.

The regulating inhaler made by Krohne and Sesemann meets every requirement. I may remark, however, that the feather which is supposed to guide the administrator as to the continuance of respiration is an unnecessary part of the apparatus, as the anesthetist should have eyes for nothing but the movements of the chest wall itself. I have used this apparatus over 150 times during the past two years, and on no single occasion has the condition of the patient given rise to any alarm.

There is a great difference in the quantity of chloroform used by this method and that required when the ordinary means of administration on a towel is employed. With the inhaler the amount is from one-half to onequarter that required when other methods are used. There is an almost uniform absence of the unpleasant symptoms of struggling and vomiting. [From a table with which Mr. Arnold has furnished us it appears that of twenty consecutive cases struggling occurred in one only-a confirmed alcoholic-and vomiting in one.] The time occupied in putting the patient under varied from a minute or two up to ten, fifteen or twenty minutes.

The struggling in alcoholics is not that of asphyxia, but appears to be due to an action on the higher centers in some way altered by continual soaking in alcohol, and so rendered peculiarly susceptible to the excitant properties of chloroform which normally should not be evident. It betrays the fact of alcoholism at some period of the patient's history, and is almost pathognomonic.

At the annual convention there will come up for discussion the report of the committee appointed to recommend a revised constitution for the association. We herewith present the report of the committee, together with the draft of the proposed constitution in full, so that members may read it before the convention and thereby save discussion. The following is the report:

To the National Association of Railway Surgeons.

Your special committee appointed at the last annual meeting to revise the constitution and by-laws, respectfully, report that taking the old constitution as a basis they have made such alterations or changes as seemed to them proper, and submit the following for your consideration. W. A. Ward, M. D., Chairman of Committee.

Section 1. The members of the Association shall consist of two classes, active and honorary.

Sec. 2. The active members shall be surgeons of railway companies at the time of their admission to membership, provided, however, that when a surgeon is once a member, his retirement from the service of the company shall not forfeit his membership.

Sec. 3. The honorary members shall comprise such persons, not necessarily railway surgeons, as may from time to time be elected, and accorded the usual privileges of such membership.

Sec. 4. All propositions for membership shall be made in open session, referred to the executive board, and on their report, elected by a two-thirds vote of the members present, provided, however, no report shall be made or election held on the same day of the session that the name is proposed.

ARTICLE III.

Section I. The officers of this Association shall consist of a president, five vice-presidents, a secretary and an assistant secretary, a treasurer, also an executive board of seven. All of whom shall be elected annually by ballot, to serve until their successors are elected, except the executive board, four of whom shall be elected in even years and three in odd years.

Sec. 2. Nominations may be made at the morning session of the second day, limited to five for each office, and for the executive board to twice the number to be elected.

Sec. 3. The election shall be in order at the opening of the afternoon session of the second day, a majority of all votes cast necessary to elect, and after the second ballot, if no election, all but the two receiving the highest number of votes shall be dropped, and the ballot confined to the two so designated. Of the executive board, a member receiving a majority shall be elected, until the number is full, the lowest being dropped on each ballot.

Sec. 4. All officers elected shall assume

their several stations before the close of the morning session of the third day.

ARTICLE IV.

Section 1. The president shall preside at all regular and special meetings and perform all the other duties that custom and parliamentary usage may require, and deliver an address at the annual meeting over which he presides.

Sec. 2. In the absence of the president, the vice-presidents shall perform the duties of his office in the order of their election.

Sec. 3. The secretary shall keep a record of the proceedings of all meetings and draw all orders on the treasurer for the payment of bills, shall attend to all correspondence of the business of the Association, notify all members of meetings, and upon request of the chairman, give notice of meetings of committees during recess of the Association, and upon request of the president, shall issue such circular letters regarding the business of the Association as may be deemed desirable, and shall be ex-officio a member of the committee on arrangements.

Sec. 4. The treasurer shall have immediate charge of the funds and property of the Association, shall collect all dues, giving his receipt therefor, pay out money only on the order of the secretary, countersigned by the president, and shall give bond to the president to faithfully account for all funds coming into his possession belonging to this Association; the amount of the bond to be determined by the executive board. He shall also make a written statement to the president of the financial condition of the Association one month after the annual meeting. He shall communicate each year with all members who have not paid their annual dues and solicit payment of the same.

Sec. 5. The executive board shall fix the annual dues and membership fee, subject to the approval of the Association, and act as a committee on credentials, audit all accounts, and, in conjunction with the other officers of the Association, hold any necessary meetings in the interval between sessions deemed desirable and necessary in the interests of the Association, and such a conjoined action shall be deemed an action of the Association as a whole.

A Committee of Publication. The first three of whom shall be appointed and announced by the president before the adjournment of the final session.

Sec. 2. Special committees may be provided for at the pleasure of the Association.

Sec. 3. The committee on arrangements, a majority of whom shall be actual residents of the town or city in which the annual meeting next succeeding their appointment is held, provided there are that number of resident members, shall be required to to provide suitable accommodations, including committee rooms, together with a list of hotels and rates per day; to receive and announce all essays, memoirs, and publish the title and name of the author of the same in the programme for the meeting, which programme shall be sent to all members entitled to seats in the annual meeting at least three weeks prior to the date of such meeting, and make any other necessary arrangements.

Sec. 4. It shall be the duty of the committee on transportation to ascertain the terms and conditions upon which the various railway lines will carry the members to and from the place of meeting, and to notify each member of the Association through the committee of arrangements, or otherwise, of the same at least one month prior to the annual meeting.

Sec. 5. The committee on necrology shall report annually brief biographical notes of the deceased members, and preserve statistical and other memorial records of the society.

Sec. 6. The committee on publication shall be composed of the president, secretary and treasurer, and shall have charge of preparing for the press such of the proceedings of the society as may be ordered to be published. And they shall have full discretionary powers to omit from the published transactions any part or whole of any paper that may be referred to it by the Association unless especially instructed to the contrary by the vote of the Association.

ARTICLE VI.

Section 1. The annual meeting of this Association shall be held between the first and last Mondays of May in each year, at the place agreed upon by the Association the preceding year, the particular date to be fixed by the executive board, and notice sent to each member of the Association not later than October of the current year. The session shall continue three days, or until all the business of the society is completed and a formal adjournment had.

Sec. 2. Special meetings may be had upon the call of the president of the Association, signed by the secretary, at the request of a majority of the officers, or the executive board, and the business to be considered must

adopted, otherwise they shall lie over until the next annual meeting, and then adopted only by two-thirds vote of all the members in attendance.

PROGRAMME FOR THE CONVENTION.

We present herewith the full programme of the papers to be presented to the convention, as arranged up to date:

1. "The Treatment of Functional Nervous Affections Due to Trauma," by Dr. John Punton, Kansas City, Mo. Discussion to be opened by Drs. H. M. Moyer and H. T. Patrick.

2. "Relief and Hospital Departments," by Dr. Frank H. Caldwell, Waycross, Ga. Discussion to be opened by Drs. W. B. Outten and George Chaffee.

3. "Relation of Railway Companies to State Boards of Health," by Dr. G. P. Conn, Concord, N. H.

4. "An Exhibition of Various Devices for the Determination of the Color Sense of Railway Employes," by Dr. C. W. Tangeman, Cincinnati, O. Discussion to be opened by Drs. J. A. Owen and J. F. Fulton.

5. "The Beneficial Influence Exercised by Railway Hospital Associations Upon the Morals of Employes," by Dr. George W. Hogeboom, Kansas City, Mo.

6. "Accidental or Railway Surgery," by Dr. C. B. Stemen, Fort Wayne, Ind.

7. "Observations Upon and Reasons for a More Complete Physical Examination of Railway Employes," by Dr. Henry F. Hoyt, St. Paul, Minn. Discussion to be opened by Drs. W. D. Middleton and J. W. Kaster.

8. "Treatment of Fracture of Humerus. Radius and Ulna, with Involvement of Wrist Joint," by Dr. H. L. Getz, Marshalltown, Ia.

9. "A Case of Intercondyloid Fracture of the Femur," by Dr. F. W. Schmidt, Riverdale, Ill. Discussion to be opened by Drs. A. I. Bouffleur and A. L. Cory.

10. "Dislocation of Hip Joint, with Report of Cases," by Dr. Solon Marks, Milwaukee, Wis. Discussion to be opened by Drs. J. N. Jackson and J. B. Hamilton.

II. "Traumatic Infections and Their Treatment," by Dr. W. T. Sarles, Sparta, Wis. Discussion to be opened by Drs. H. F. Hoyt and A. I. Bouffleur.

12. "The First Care of the Patient in Railway Traumatism," by Dr. A. L. Fulton, Kansas City, Mo.

12. "Plaster of Paris and the Difficulty of Applying it to Recent Fractures," by Dr. A. C. McClanahan, Red Lodge, Mont. Discussion to be opened by Drs. A. D. Bevan and Alton. 13. "Hernia as a Factor in Personal Dam