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veterate hunter and thoroughly informed about the locations where game was most abundant. Hence they sought the doctor and begged that he accompany them, a request which was readily acceded to. The doctor soon demonstrated to his new acquaintances that he was an unusually well informed man, being highly educated and a splendid talker. Like all good talkers, he gave evidence more than once of a love for the unusual and startling, and seemingly was in love with the experimental. His talk was always full of the suggestive, his ideas filled at times with not only the quaint, but the far-off, dreamy and impractical.
It had been an unusually exciting and successful day in the way of bagging game, and after the day's hunt in the evening they were seated in their car exchanging views and rehearsing their various experiences, when one of the gentlemen present, turning to the doctor, said:
"Doctor, I am not given to flattery, but it has puzzled me as to how an intellectual and well-posted man as you plainly are, can content himself in such an out-of-the-way place as this, for here there does not exist even an ordinary future."
"Very true, sir," said the doctor, "but with me it is not a matter of preference, but a matter of necessity. Some six years ago my health became bad from a lung trouble, and consumption being in my family, I was amply warned. Upon examination evidences were found that I was consumptive, and I did not wait, but started at once in search of a climate which would benefit me. I went West into the Rocky Mountains. Here I tested various climates and altitudes and found that a high altitude rendered me excessively nervous, and it was immaterial how beneficial a high altitude might be in preventing a propagation of the bacilli in my diseased lungs, it would certainly have killed me by exhausting my nervous system. I found that an altitude of 5,000 or 6,000 feet above the sea level rendered me as nervous as an hysterical woman, causing an utter inability, to sleep, and an absolute inability to remain quiet. After a good deal of experimenting I arrived at this place, which, as you see, has an equable temperature, and is only 2,300 feet above the sea level. My first advent here was anything but encouraging for I had
scarcely been here 36 hours before I contracted a fever which persisted for a long period. After that I gradually improved, began to sleep and eat like a healthy man.
When I came here I weighed a little over 92 pounds; now I weight 186 pounds-over twice as much. I have been away from here several times, only to return a very sick man. Hence I believe that this is the only place on earth where I can live in health. To you gentlemen who can ceaselessly change your location and revel in the luxury of an endless variety, this may seem strange, but there are many others like me who can live in only one locality, denizens of limited space."
"But, doctor," said another gentleman, "I would think that the dull, unceasing monotony of your surroundings would wear upon and create in you a restless discontent,"
"My dear sir," said the doctor, "I for one would much prefer to face discontent than continued discomfort, pain and death; but, gentlemen, God has so made us that every man has within him the elements of contentment. Content does not abide in any locality; you may be in a desert of discontent in the heart of Paris or New York, for content only abides in the brain of man. Between my practice, study and recreation I live a tented life. I have a fine microscope and there is scarcely an animal or a plant which I have not investigated under the microscope. . I have prepared many specimens and wellmounted slides. I commune with nature, and in the labor obtain my content."
At this juncture one of the party who had been outside returned with a large centipede, which had been killed, lying upon a board; it was inspected and for the time being was the object of much curiosity, speculation and disgust. The gentleman who had brought it in said:
"This is the thousand-legged monster whose bite kills, and I have heard that the tarantula's bite is even more fatal."
"I beg your pardon, sir," said the doctor, "that is an incorrect assertion, for neither the sting of the centipede nor the bit of the tarantula are fatal to the human subject. You will notice the number of legs the centipede has. Each and every leg is armed with a poisonous sting, and when it runs over a surface and you try to brush it off each leg intuitively
clutches the surface upon which it happens to be, and if it is on the skin of man, each sting attached to a leg clutches and penetrates the skin, poisoning wherever these stings penetrate, and you have mortification of the part stung, and a slowly healing sore results. Sometimes weeks and months ensue before recovery, but the centipede's poison only acts locally and never affects the blood. This is equally true as regards the tarantula and scorpion. No, gentlemen, the bite or sting of the centipede, tarantula and scorpion are never fatal; they are only locally poisonous."
"Well, that is very strange," said one gentleman. "I had always heard that the sting of the centipede was almost surely fatal."
"Yes, sir," said the doctor, "you now and then hear of death resulting from the bite of a mosquito, spider or even a fly, but such deaths are purely accidental, depending upon the lowered condition of health of the person bitten. They are incidental coincidences; these people are always sick before they are bitten."
"But, doctor," said another gentleman, "what is the best way to lessen the danger of the stings of the centipede?"
"I thank you, sir," said the doctor, "for suggesting the thought. Now then, gentlemen, to illustrate this thing better I will relate to you a story, and along with it give you some thoughts which have come to me and speak of some experiments which I am now making. I have studied the various ways in which antitoxines are prepared, for all of the advances made in the treatment and cure of the most violent forms of disease depend upon the action of a poison against a poison. Healthy animals, generally horses or asses, are taken, and a special poison is injected into the blood of the animal; gradually larger and larger doses of the poison are thus injected until this poison ceases to have effect. Then the horse or ass thus treated becomes immune to the poison and is said to be immunized. Now then, as much blood as is needed is taken from the animal and allowed to settle in properly prepared vessels; everything is removed from it but the waterly part, or what is called the serum; it is then treated so as to render it free from any doubtful substance. When it is ready for use and thus made it is injected with an hypodermic syringe into the blood of the human subject for the treatment of diphtheria
and other troubles. It has been shown that this immunized serum has the power to kill bacteria and other microbes. I have studied this branch of medicine as only a man can who feels the absolute necessity of keeping his mind occupied.
"About a year ago, in the latter part of April, a party of us had gone out for a plover hunt; it was a quiet day and we had some good sport. When we arrived at B- Lake one of our party determined to take a swim; he had finished his bath, and in coming out came up a bushy path, when I suddenly heard him yell and saw him frantically brushing something off the front part of his thigh. We hastened to his aid, when he said that he had been stung by a centipede and I could see a series of bright red dots in parallel lines corresponding to where the stings had gone in. I had nothing with me; not even whisky. I had often carried a little case containing a small bottle of a four per cent. solution of the permanganate of potash, a small bottle of ammonia, a small bottle of absolute alcohol and a hypodermic syringe, but when needed they were not to be had.
"You can rest assured that my mind acted rapidly as to what had best be done. We were nearly eleven miles from this point. At this juncture I happened to notice a chaparralcock, or road runner. Knowing the habits of these birds and having studied the antitoxines, there flashed through my mind the following line of thought. Here is a bird which eats centipedes, tarantulas, etc., with impunity; why should not his blood possess more or less immunizing power. Here was a ready-made serum, and perhaps this blood might neutralize the venom of this centipede's sting. I at once shot the cock and hastily split open its breast, and tearing a piece from my shirt I saturated this piece with as much blood as I could and applied it upon the wound. The quantity was so small five or six birds were killed in order to thoroughly cover and protect the wound. The parts were then bandaged as best I could, after which we hastened home.
"Naturally I took great interest in the result of the treatment of this wound, watched the patient closely and found that he did not become feverish, and, to my surprise, no mortification occurred, and my patient was well within a week. Now then, gentlemen, I may
be mistaken, but I honestly believe that all around us are natural antidotes to the most violent poisons. I believe that while the craw of the chaparral-cock may modify the poison of the centipede, its blood is an antidote to the sting of a centipede, and perhaps of the tarantula and scorpion as well.
"I am at present experimenting with the hog, immunizing his blood with the venom of the Crotalus Confluentus or rattlesnake, and if my reasoning be correct I am convinced that the time will soon come when I can prepare an antidote to this poison. I have been at work only three months, but I have a world of hope of succeeding in what I have started out to demonstrate."
"But, doctor," said a gentleman, "I have been led to believe that the hog is a most unsanitary and infected animal."
"True, sir, but I maintain that it is the most resistant animal on the face of the earth. It can stand any and all kinds of hardships, and seemingly any and all kinds of reptilean and animal poisons. Did any of you ever hear of a hog having hydrophobia? Now, in the treatment of hog's serum it can be rendered as pure as any other form of serum, and I maintain that there will come a time when we can demonstrate that it possesses the best of all qualities for immunizing, for what will kill horses and asses and other animals will not feaze a hog. Mark my word, gentlemen, the immunized blood of a hog will one of these days come nearer curing consumption than the blood of any other known animal."
"Well," said a gentleman, "let us trust that your enforced residence in one locality will be the means of benefiting an entire world."
"I trust so," said the doctor. "Thank God, that talent and genius cannot be confined within the limits of a Chinese wall; discovery and result are made by brains, and not by regions. Good night, gentlemen.”
THE WABASH RAILWAY SURGICAL
We are not like the legal profession, with a supreme court decision upon which to rely, but must accept the conditions as we find them, and with the enlightenment of personal experience, based upon a fundamental scientific education and the experience of our fellows, we start for the shore in as seaworthy a craft as can ride a wave, thus giving to all who fall into our hands the benefits of the most modern treatment, be they the tramps upon the right-of-way, the employes at their posts, or the passengers, all alike receiving the attention of the skilled laborer, who deals not alone with the mechanical part of man, but is in active sympathy with the psychical as well. We congratulate ourselves that the chief surgeons of the Wabash have all been men in the regular line of professional work, showing the care and judgment exercised by the company in trying to give, not alone to the employes, but all who are so unfortunate as to come within the province of the department, the
By E. R. LEWIS, M. D., KANSAS CITY, Mo.
The Wabash Railway Surgical Association is purely scientific and philanthropic in its or
ganic being; is not a trade union and appeals highest order of medical and surgical service.
In making this statement I wish to assure all
* The president's address at the annual meeting of the Wabash Railway Surgical Association, held in St. Louis, November 1896.
to the highest and most unselfish part of humanity. It was organized in January, 1882, at Decatur, Ill., by Dr. Joseph T. Woods of Toledo, Ohio, then chief surgeon of that part of the Wabash system east of the Mississippi river, and at the time organized constituted the first of its kind known to the service. Some of us here to-day were regularly appointed surgeons eight years before that time upon a line. west of the Mississippi river which now forms that part of the system west of St. Louis.
After a varied experience in railway surgical work extending over twenty-one years I can, and do, say it is one most largely of philanthropy; and he who views it from a purely mercenary standpoint reduces himself and tries to reduce his profession to the level of a trade. The conditions calling for the organization of a band of surgeons like this are multiple; but the most important, as I view it, is for the purpose of personal improvement in our common work, that we may the better be enabled to compete with the complications of emergencies by instructing the whole from the experience of the individuals, thus bringing to bear the consensus of opinion to in turn enlighten the individual; and in this special line of work we must all realize how very important this has been.
that this fact, to me, redounds to the lasting credit of this association, whose continued organization has been made possible by the good judgment and aid of the chief medical and surgical officers since its beginning; and I challenge anyone to point to a like number of men banded together who can, and do, better work for all concerned.
The veteran president of the Wabash railroad, Mr. O. D. Ashley, has from the beginning greatly aided in the effective work of this association by giving encouragement and good cheer, ever ready to adopt that which is clearly an advantage in any and every department of the service, keeping fully abreast with the age, and far in advance of other more pretentious lines in this country, and the general managers, without exception, have sustained its benign workings.
There is certainly no state in the union that can truly boast of a more equitable, just and philanthropic set of railway management toward the injured than the lines operated from, or passing through, Missouri, and I believe the surgeons and physicians engaged in this work have devoted that time and attention necessary to the work to justly entitle them to the first rank in this special line; and certainly none have thus far excelled the Wabash Surgical Association, and our effort has been to let him who best can, and will, instruct the whole, and at the same time realizing that the greatest advances in our profession have sprung from little things and individual effort; thus admonishing us that in this line of work there are no successful back numbers to-day, and if we are not abreast with the wonderful progress of our profession, we, too, must be side-tracked and give place to more modern equipment, that the engine of the times may not be impeded.
Henry H. Middelkamp.
Dr. Henry H. Middelkamp of Warrenton, Mo., was born January 27, 1839, in Warren County, Mo. He was the eldest child of John H. and Margaretta M. Middelkamp, natives of Germany.
He was educated in the common schools of Missouri, with private instructors in math
ematics and the languages, and received the honorary degree of A. M. from the Central Wesleyan College, Warrenton, Mo., June 16, 1891. He began to read medicine at Warrenton in 1862, under Dr. John E. Hutton, then of Warrenton, a member of Congress in 188488. Dr. Middelkamp attended two courses of lectures at the St. Louis Medical College and graduated March 4, 1864; he also took short post-graduate courses at the same institute.
He practiced medicine at Warrenton from March 12, 1864, until his death. He was the founder of the Linton District Medical Society, November 19, 1872, and was its president until 1874. He was a member of the Missouri State Medical Association, and its president in 1884-85; also a member of the American Medical Association; of the Ninth International Medical Congress; of the Mississippi Valley Association; of the St. Louis Medical Society; of the Wabash Surgical Association; of the National Association of Railway Surgeons; an honorary member of the St. Charles County Medical Society, and a member of the Masonic Fraternity.
Dr. Middelkamp was lecturer on surgery in the medical department of the State University at Columbia, 1876-79, medical examiner for the department, 1876-80, and curator of the university, 1877-79. He was a member of the board of health of Warrenton, 1892-97; physciian to the county, 1879-80; county superintendent of public schools, 1870-72, and surgeon to the Wabash Railroad since 1884. He performed all the capital operations common to railway surgery and devised special apparatus for the treatment of wounds and fractures. He published the following: "Presidential Address," State Medical Association (Medical Education); "Personal Qualifications of the Surgeon;" "Immediate Amputations," and other papers. He was married September 11, 1864, to Miss Ellen Smith of St. Louis, Mo. Their children are W. A. and E. G., Marion Sins and Katherine E., Geo. H., Harry and Herbert H., the three last deceased.
Dr. Middelkamp died April 19, 1897, after being ill since September 25 last. Seven months of that time he was confined to his bed. Up to the last week of his life his patients came to his bedside for advice and help; this seemed to give him great pleasure to be able to alleviate the sufferings of others if he could not get relief himself.
A New Osteoplastic Amputation of the Foot.
The following is from the editorial columns of the New York Medical Journal:
Professor Z. Samfirescu, director of the laboratory of operative surgery and topographical anatomy of the Jassy faculty of medicine, and his assistant, Dr. H. Solomovici, have devised a new osteoplastic amputation of the foot which they describe in the February number of the Revue de chirurgie. It does not seem to have been performed on the living subject yet. The authors remark that it is a modification of Quimby's operation analogous to Pasquier and Le Fort's modification of Pirogoff's. Quimby, they say, in order not to deprive children of the epiphyseal cartilage of the tibia, divided the calcaneum vertically and interposed the posterior portion, retained in the flap, between the malleoli, without removing anything from the tibio-fibular mortise.
The authors describe their operation as follows: As guiding points for the flap incisions they take the tubercle of the scaphoid bone internally, a corresponding point above the fifth metatarsal bone externally, and the outer border of the insertion of the tendo Achillis. The thumb and forefinger of the left hand, spanning the sole of the foot, with the hand. supine, are placed one on each of the two corresponding guiding points. The distal part of the foot is bent downward and inward, and the point of the knife is inserted near the third guiding point, the outer border of the insertion of the tendo Achillis, whence a horizontal incision is carried forward to the immediate vicinity of the end of the external malleolus, and then still farther forward to the other external guiding point, just above the tubercle of the fifth metatarsal bone. Then the incision is carried over the instep toward the scaphoido-cuneiform articulation, the foot being held outward, until it reaches to the tubercle of the scaphoid bone.
Then, with the left hand pronated and embracing the dorsum of the foot, the foot is held up toward the leg, and the plantar incision is made. It is deep, and, beginning at one of the two corresponding guiding points-the tubercle of the scaphoid bone in the case of the right foot-it forms a loop in front of the calcaneocuboid articulation and extends to the other corresponding guiding point over the fifth metatarsal bone. All the muscles and tendons are then cut to the bones. The dorsal flap is dissected up to the tibio-tarsal articulation, and the plantar flap to the calcaneocuboid articulation.
The next steps are the tibio-tarsal disarticulation and a horizontal section of the calcaneum. The joint is attacked from the outer
side, as advised by Farabeuf. An assistant holds the leg flexed at a right angle with the thigh, with the knee turned inward and the lower part of the leg resting on the edge of the table. With the dorsal flap raised, the external ligament is divided beneath the end of the malleolus, opening that portion of the joint which is found between the malleolus and the outer articular surface of the astragalus. By this incision the three external ligaments are divided, the anterior and posterior astragalo-peroneal and the calcaneo-peroneal. The foot is now turned inward, and the slender anterior and posterior ligaments are divided. The fat lying upon the calcaneum is removed, exposing the insertion of the tendo Achillis, and in front of that tendon is placed the saw for making the section of the calcaneum. Almost a finger's breadth of the bone is removed posteriorly, but, anteriorly, the section stops beneath the lesser apophysis of the calcaneum. The section is made from behind forward and from within outward until the saw reaches the calcaneo-cuboid joint, at which disarticulation is then performed. In this procedure it may be well to remove the anterior cartilaginous portion of the calcaneum for a distance of from a third of an inch to an inch, especially when the operation is one of necessity and there is not enough left of the soft parts to admit of fashioning the flaps according to rule.
The malleoli and the tibio-fibular mortise are prepared to receive the lower segment of the calcaneum in the following manner: The skin over the malleoli is dissected up to the base, but the periosteum is left in place. The articular cartilage of the malleoli and of the mortise is scraped, preferably with a raspatory. As the mortise presents an antero-posterior concavity, the anterior and posterior lips of the hollow are cut away with scissors, in order that the surface may be plane for the coaptation of the cut surface of the calcaneum. Then, still with the raspatory, the periosteum is separated from the calcaneum on each side for a sufficient space to make the bare bone come in contact with the inner surfaces of the malleoli. The segment of calcaneum, still attached to the plantar flap, is then gently forced in between the malleoli, which hold it fast so that no bone sutures are needed. It is well to shorten the outer malleolus a little, but this is hardly necessary with the inner one.
Be a friend of fresh air, Get out in the breeze; Fresh air is a doctor Who charges no fees.