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Dr. Highsmith said he had every reason to believe in venesection in certain cases, and particularly in cases of violent pneumonia. His attention was first called to this class of cases by an instance which occurred in his own practice. The patient having pneumonia, pronosticated as fatal, made an early recovery after a severe hemorrhage from the
Dr. Stemen said that he used to be afraid to go to see his patients without his lances. Said he had bled no one for a number of years by opening a vein. Remembered having bled a railroad man frequently for vertigo. The patient finally had an attack of vertigo for which he was not bled and died from apoplexy. He also referred to a case of convulsions caused by impaction of seeds in the rectum.
Dr. Thorn stated that he had bled in pneumonia, pleurisy and eclampsia. He thought that in such cases venesection was of signal benefit when used with ordinary discretion. He said he had also bled for injuries of the chest, and took his cue from a case of injury to the chest which came to the clinic of Dr. Van Buren of New York, bleeding being resorted to.
Dr. Rickey said that he thought much of the supposed effect from bleeding came from psychologic effect, and cited the case of an old lady who insisted upon being bled once a year, and who was served equally well one year by having the arm scratched and a little warm water poured over the arm in a manner similar to the trickling of the blood in venesection.
Dr. McCandless reported a case of transverse fracture of the patella, and called particular attention to the fact that physicians. must be sure that the fractured surfaces accurately approximate, if satisfactory results are to be secured. There is always a tendency for the edges of the apponurosis to drop in between the bones. The operation that he recommends is to tie the two surfaces together with kangaroo tendons, and if ordinary care is exercised the operation will result in perfect union.
Dr. T. B. Campbell read a paper on "The Value of Drainage and Irrigation in Septic Inflammation, with Report of Cases."
Dr. Weitz thought that the surgeon could not be too precise in effecting thorough drainage and irrigation in all forms of septic inflammation, and that as in railroad injuries we frequently find cases in which drainage and irrigation has not only been neglected, but is urgently demanded, he thought the paper a very timely one.
Dr. Young thought that the continued use of a strong solution of either bichloride of mercury or carbolic acid was dangerous, and he therefore resorted to a solution of bi-car
bonate of soda, which he thought answered the main purposes.
Dr. Duncan reported a case in which a drainage tube had remained for eleven months before being removed.
Dr. Josepr Pouge read a paper on "Operation for Empyemia," in which he advocated the thorough evacuation of pus.
In discussing the paper, Dr. McCandless said that when there is a large accumulation of pus in the chest cavity it is dangerous to evacuate and wash it out at once. In such cases the pus should be removed gradually, though there is no question but what it should be removed thoroughly. He stated that he had seen plastic material on the inner wall of the chest one-half inch thick. If the pus is circumscribed it is allowable to remove it all at once. He thought that there was such a thing as too much irrigation.
Dr. Andrews said that in many cases of empyemia did not primarily originate as such, and that in a large proportion of these cases he would not irrigate at all, as he thinks that the case will recover more certainly and quickly if we do not irrigate. Irrigation is liable to set up an impulsive pneumonia. He said that he had seen the cavity in a small child healed up in two weeks without any irrigation. In chronic cases he sometimes used an irrigating solution composed of iodine and water mixed to the color of sherry wine. He thought it well to remember that the infection of empyemia is often due to the pneumococ
Dr. Andrews reported 184 operations for radical cure of hernia and described the various recognized operations for hernia. He stated that in the injection method relapses are liable to occur and usually before the lapse of a year. Aside from this the injections often cause permanent injury, the hernia becoming irreducible. If the injection is repeated every six months, in skilled hands, the hernia may possible be cured. The thought the radical cure the only one worthy, of extensive use, and advocated the use of the kangaroo tendon, which will last about three months.
The following cases were reported: "Retained Soft Rubber Catheter in the Bladder, with Formation of Stone," by Dr. Gillaspy; "Removal of a Slate Pencil from the Bladder," by Dr. Highsmith; "Removal of a Stone in the Bladder Formed from a Nucleus of Chewing Gum," by Dr. Lewis; "Removal of a Small Pocket Knife from the Bladder of a Young Girl," by Dr. Rickey.
The following paper was read by title: "A Plea for Incineration of the Dead," by Dr. B. Lincoln.
The following officers were elected to serve for the ensuing year: President, Dr. Miles F. Porter, Fort Wayne, Ind.; vice-president, Dr.
George R. Highsmith, Carrollton, Mo.; secrétary and treasurer, Dr. C. B. Stemen, Fort Wayne, Ind.
St. Louis was selected as the next place of meeting to be held on the second Thursday of November, 1897.
Symbolism, Drachm and Ounce vs. Drachm and Fluid Drachm, Ounce and Fluid Ounce. Austin, Tex., March 23, 1897.
To the Editor:
The almost universal custom among physicians of writing 5 and 3 in inditing prescriptions, exclusively, without regard to solidity or fluidity, seems to me exceedingly inappropriate and in bad taste. It is true the meaning in either case is obvious enough, but the beauties of appropriateness and exactitude in writing or in speaking along this line are found in the opposite formula. The 3 and 3 are weighed and the f3 and f3 are measured. Entirely different are the instrumentalities that are employed in their reckoning and what a dissimilarity in the things to which they refer! The character of the material, solid or fluid, suggests whether it is to be the scales or the graduating glass which is to be used in its manipulation, plainly enough, nor does it matter, that one contemplates grains and the other minims; practically it is the same; but what an injustice is done to refined and exact language! We could say with usual clearness as to our meaning "mule power" or "mare power" for horse power, but what a jar it would cause cultivated and refined sensibilities. On account of a regard for the "eternal fitness of all things" we should call things by their names, be exact in our allusions. Measure in medicine means "fluid measure," the graduating glass, and not the scales, or any computation of bulk by means of weights. A fluid (in spite of the suggestiveness of its materia medica name) should have its quantity prefixed by f, since measurement and not weight is contemplated. The example of our forefathers is old, but still a good one; let us continue it. The same, of course, applies to the use of gramme exclusively in lieu of gramme and cubic centimeter, solid and fluid respectively.
W. NEAL WATT, SURG. A. & N. W. R. R.
Notices and Reviews.
The Fort Wayne Medical Journal-Magazine.
The Journal of the Medical Sciences, which has for sixteen years been issued from Fort Wayne, Ind., has been united in marriage to the Fort Wayne Medical Magazine, which was established four years ago. The marriage was consummated January 1, and the result of the union is certainly most creditable to all concerned. We wish the new journal success and prosperity and have no doubt that under the excellent management of Dr. Bulson the present excellent quality and appearance of the Journal-Magazine will be maintained.
BOOKS AND PAMPHLETS RECEIVED.
"Public Health Service in the United States," by Walter Wyman, A. M., M. D. Reprinted from the Cleveland Journal of Medicine, February, 1897.
"Mules' Operation for Artificial Eye," by Frank Allport, M. D. Reprinted from the Northwestern Lancet, 1897.
"Report of a Case of Gastrostomy," by M. F. Coomes, A. M., M. D. Reprinted from the American Practitioner and News, October 31, 1896.
"Congenital Ptosis-The Operation Devised by Panas for Relief Modified." By M. F. Coomes, A. M., M. D. Reprinted from the American Practitioner and News, December 12, 1896.
"The Technique of Operations for Acute Appendicitis," by Weller Van Hook, A. B., M. D. Reprinted from the Journal of the American Medical Association, February 26, 1897.
"A Basis for the Diagnosis of the So-Called Inflammatory Diseases of the Uterus," by C. S. Bacon, B. Ph., M. D. Reprinted from the American Gynecological and Obstetrical Journal, January, 1897.
"A Plea for Preliminary Iridectomy in Cataract Extraction," by David W. Stevenson, M. D., Richmond, Ind. Reprinted from the Transactions of the Indiana State Medical Proceedings, 1896
"Failures of Midwives in Asepsis," by C. S. Bacon, M. D. Reprinted from the Journal of the American Medical Association, February 6, 1897.
"Hysteria in a Man; Tumor of the Brain; Locomotor Ataxia and Dementia Paralytica," by Hugh T. Patrick, M .D. Reprinted from International Clinics, Vol. LV, sixth series.
BY JAMES G. HUNT, M. D., UTICA, N. Y.
The fact that I have been associated with the railroad men for so many years as railway surgeon enhances the great pleasure it affords me to be able to be here to-night to talk to you. The subject of the lecture which I propose to give you is "Railway Surgery." This will include fractures, sprains, contusions, shock and other injuries that occur on the road and in the shops. It will be my endeavor to present to you these different topics in such a manner that you will be able to thoroughly understand me, using terms which are familiar to all, save when obliged to introduce medical terms, because I cannot well express myself by any other. I hope by the aid of the manikin, the skeleton and charts to be able to make my talk quite clear to you all.
The great improvements in railways and their equipment, as well as the wonderful developments which have raised the service to its present high standard, have been brought about during the lifetime of many persons who are yet living. The wonderful, as well as the rapid, changes that have taken place since the time, sixty-five years ago, when Peter Cooper, with his one-ton engine, was experimenting, are shown by the following figures:
In 1830 there were only 23 miles of railway, and in the following year only 72 miles more, making a total of 95 miles.
In 1840 there were 3,000 miles.
In 1890 there were 175,000 miles, and at the present time there are about 250,000 miles.
From statistics it is shown that the brains, as well as the muscles of over 2,000,000 men have been employed in the building, equipment and operation of the present railway sys
A lecture delivered before the railway branch of the Y. M. C. A. at Utica, New York, February, 1897.
tems. The railway officials throughout the country have made great and rapid progress in reducing the number and severity of accidents, and our first-class roads now compare more than favorably in this respect with the best railways of Europe. The possibility of railway accidents has always been a source of anxiety to railway managers and the shock received by the public should deepen the interest in the means taken to avoid all painful occurrences of this kind.
Many of the injuries which the railway surgeon has to deal with are of a peculiar nature, and oftentimes they are quite severe, but fortunately a majority of the cases are of a minor character, such as naturally follow in the coupling of cars, or from accidents in the car shops. Many of these accidents happen at night, and at some out-of-the-way place, distant from medical assistance, and frequently in the most disagreeable weather. In such cases the delay and exposure are influences that may add greatly to the shock of injury before the sufferer can receive proper attention.
The object aimed at in these plates [exhibiting a manikin and charts] is to give a view of the human structure on the scale of life, and to show exact representations of the parts as they appear in life, thus furnishing both the the physician and the layman with correct information, which shall be a sure guide in all cases requiring an intimate. and thorough acquaintance with the anatomy of these parts.*
The speaker, Dr. Hunt, then explained the different plates of the manikin, which numbered over fifty, illustrating the muscles, ribs, lungs, heart, liver (A), normal condition; (B) nutmeg or "gin" degeneration from the use of alcohol; (C) cheesey degeneration from the effect of long drinking; (D) cancerous liver; the interior of the stomach, showing the effects of moderate drinking, also condition in delirium tremens; the intestines, arteries and veins, general circulation of blood, nerves, brain and spinal cord.
The skeleton of the head and trunk were also shown and the doctor pointed out the manner in which many surgical operations are performed. He then exhibited charts of magnified sections of the nervous tissues, muscular fibers, mucus membrane of the stomach, the larynx cut open to show the vocal cords, sections of the kidney, microscopical section of the "nutmeg" liver from the use of alcohol, microscopical section of a healthy liver, section of a drunkard's kidney, section of a healthy kidney, microscopical section of the lining of a healthy stomach and a similar section of a drunkard's stomach.
Probably four-fifths of the injuries that claim the attention of a railway surgeon may be classed under the head of "Minor Surgery,"
and it is in the treatment of these cases that the true surgeon is shown, just as certainly as where there are amputations, resections and operations of that class. There is often entirely too much of a disposition to overlook the necessary minutiæ of the smaller operations in which, with proper treatment, good
results should be obtained. There are several points that I wish to impress upon you, and the first is the wonderful recuperative or healing power in the fingers and toes. We are often called to look at a "mashed" or crushed finger, hand or foot. At the first glance there seems to be no hope of saving the member, and there is a disposition to amputate. My advice is to always look twice, wait a little and see what can be done toward saving the member. Do not be in too much of a hurry to cut. When the finger, toe, foot or hand is once gone it is gone forever, and we cannot put it back. As long as there is the least chance of any circulation, either direct or collateral, I always try to save the finger or other member. I say to the patient or his friends: "Now, I will try and save this member, but you must take all the responsibility and chances and if later on we are obliged to resort to an amputation no blame shall rest upon me as surgeon."
Of all the cases I have had for twenty-six years years of my practice (and they have run up into the hundreds), both on the railroads and in shops and mills, I never, to the best of my recollections, have had to resort to an amputation in more than five or six instances, and as for blood poison, I have yet to have my third case, and none have been fatal. So, you see, a surgeon can succeed in ninety-nine chances out of a hundred if he will only treat the wound in an antiseptic manner in the meantime. Supposing that we do have to resort to an amputation later on nothing has been lost by waiting if the proper precautions have been taken to disinfect the wound and properly dress the whole member.
There is an abundant supply of blood vessels in the extremities which traverse and radiate throughout every fiber, and which form a complete network over both toes and fingers. So that unless the laceration extends com
pletely around the member there is good reason to believe there is sufficient vitality left to preserve a healthy regenerative action. There is also an abundant nerve supply, which fact very materially assists nature in repairing the parts.
The loss of a finger may seem of very little importance to a surgeon, but to a man who labors on the railroad and makes his living by hard work it is a serious matter, for while handling a brake his life may depend upon the firm grasp of the hand.
I make it a rule never to sacrifice the smallest part of a finger when there is any possibility of saving it. A hand with all the fingers is much better than one with four, and one with four and a portion of another is likewise far better than one with only four. For that reason we should strive to save every fractional part that we possibly can, as to the workingman it may mean much more than we imagine. There seems to be a popular idea that when the soft parts are very much bruised and lacerated they should be cut away. Do not be in too much of a hurry about this. See what their condition is a few hours after you have made the first dressing and washed the parts thoroughly with an antiseptic.
When I think back I can recall to memory a number of hands and feet that remain as a result of hard and persistent work, and limbs which have been crushed all out of shape and a few years ago would have been amputated at once, but which, under careful, painstaking treatment, have been saved. In many cases which I can recall portions of the hands and feet are neither handsome nor perfect, and at first sight you might look upon them as a poor advertisement of one's skill as a surgeon, but I look upon these cases as some of my best surgical work.
Usually when we are called to attend an accident case we find the parts that are injured, including the torn tissues, filled with coal dust and grease, and it is almost impossible to get them in an aseptic condition. Washing with alcohol and ether, equal parts, I have found to be one of the best measures for removing all this. I also wash out the parts thoroughly with a solution of bichloride of mercury, I to 2,000, at every subsequent dressing.
Many accidents occur in machine shops. They may result in contused or lacerated
wounds, the wrenching off of fingers, toes or limbs, or some of these members may be crushed. Cog wheels, saws, planing machines, belts, etc., cut or tear off many a limb, or part of one. It is such injuries as these that almost always occur when there is no surgeon that can be had for some little time, and it would be well if someone in every shop, on every train, or wherever machinery is in motion, could have some idea of what can be done before the arrival of a surgeon. If the injuries are only trifling, whether tears or cuts, wash them out in lukewarm water and put the displaced tissue, skin or flesh, in a clean white cloth. Wash out a pocket handkerchief, if you have nothing better at hand, and wet it with warm water and a little alcohol, or whisky, if you have not the alcohol. Then go or send for the surgeon as soon as you can. Even what little has been done may be the means of saving a hand or a foot, or parts of them. I am calling your attention particularly to all these little points so that you will be prepared to do something to relieve the sufferer until, as I said before, the doctor arrives. When there are large tears or lacerations the wounds must be treated by carefully removing any fragments of clothing, splinters of any sort and dirt, and washing with lukewarm water. Do not be afraid to use your thumb and fingers with reasonable care, for removing foreign matter, if you have no forceps at hand, as in all probability you will not have. Before doing this, however, wash your hands with soap and water. You have always clean waste on hand with which to wash out the parts. After you have cleaned out the wound fairly well put the torn parts in position as best you can and keep them so by bandages. Sometimes a splint is required. Never mind if it is clumsy, if for the time being it answers the purpose. It ought to be sufficiently large to keep not only the injured parts still, but also, in case of a limb, the joint above and the joint below the injury.
If the fingers or toes are crushed they ought to be washed, molded into good shape, dressed with a piece of white cloth which has been wrung out of hot water and laid upon a warm splint. If the feet or hands have been crushed they must be treated by being wrapped up in some soft, warm dressing, such as cotton, wool or waste. Cold applications are only to be
used if there be profuse bleeding. The injured parts must be supported by some sort of splint and placed upon a level with the body.
One who has received such an injury ought to be made to lie down, unless some other course is absolutely necessary or moving him is authorized by a surgeon. Such injuries rarely cause much pain, but they almost invariably cause great depression. This must be met by keeping the sufferer warm with blankets, hot bricks or bottles, and a small quantity of stimulants. When hands or feet have been torn or cut off by the wheels the stumps are to be treated as described and the limb placed in such a position that the injured point is higher than any other. Where it is an arm or leg it is to be treated the same as the hands or feet. But here the prostration is usually much greater and there is need for support with stimulants and something to keep them warm. There is no need of disturbing the clothing, except in so far as it can be cut away and replaced with warm coverings when necessary to find out the nature of the injury or to control hemorrhage.
A person may die by certain agencies which leave no traces that are visible in any part of the body. A sudden death may be produced by a blow upon the epigastrium, and yet the most searching scrutiny woulu fail to detect the slightest physical or chemical change in any organ or structure. This kind of death is termed "death from shock" and it seems to occur from sudden spasmodic contraction of the heart, or from sudden cessation of the contractility of the fibers of the cardiac walls. Shock may be caused by fright, also by drinking large quantities of ice cold water. It is quite common after a serious railroad accident, or an accident in machine shops. The signs are insensibility, drooping eyelids, feeble breathing, and great paleness with a dilated pupil, bewildered and stupid condition, cold, clammy sweats and feeble pulse. A person in this condition may die very soon and will, before long, unless assistance can be given him, and he can be brought out of the shock.
All such cases require very prompt and persistent efforts on the part of those present. A person suffering from shock should be placed in an easy position upon his back, with his head low, cover him with a rubber sheet if