Railway Surgeon DAILY EDITION. Published in honor of the Tenth Annual Convention of the National Association of Railway Surgeons. to the conventions which they ought to be, we want the sympathy and coöperation of everybody in attendance. If you will give us your help and good-will, we promise to do our end of the work. One of the most practical and altogether worthy papers which has been or will be read at the convention, was read at yesterday morning's session by Dr. Henry F. Hoyt of St. The Railway Age and Northwestern Railroader (Inc.), Paul, Minn., relative to the necessity for more MONADNOCK BLOCK, CHICAGO, ILL. Officers of the N. A. R. S., 1896-7. President. Fifth Vice-President. A. C. WEDGE, Albert Lea, Minn. Secretary. man: J. N. JACKSON, Kansas City, Mo.; JAS. A. DUNCAN, Toledo, O.; J. B. MURPHY, Chicago, Ill.; S. S. THORNE. Toledo, O.; W. D. MIDDLETON, Davenport, Ia.; A. J. BARR, McKees Rocks, Pa. Whether the attendance this year is good or not is best shown by the fact that in the first 24 hours Dr. Lewis had received more registrations and dues for the coming year than he received during the entire convention at St. Louis last year. At 10:30 a. m. yesterday-a little less than 24 hours after the first session of the convention had been called to orderthe St. Louis total had been passed with 2 names to spare. The publishers wish to express their thanks for the many kind things which those in attendance at the convention are saying about these daily papers. There may be some members present who have not taken an opportunity to congratulate us, but they must be few. And for all the good-will that has been expressed, we are heartily grateful. It is the first time that any surgical or medical convention has had a daily paper published solely for its benefit. The first year's paper must necessarily be more or less experimental, but we are endeavoring to make each issue a little better than the one of the preceding day, and we believe that members, when they look at to-day's paper, will think that we are succeeding. To make these reports of the real value complete physical examination of railway employes. An abstract of it appears in another column of this issue. Dr. W. D. Middleton, who had been requested to open the discussion of the paper, was unfortunately absent, and for some strange reason the paper did not receive any discussion. This is very much to be regretted. The field which Dr. Hoyt opened up and the suggestions which he made are of great interest. It is precisely the kind of subject on which the National Association of Railway Surgeons has an opportunity to do its most valuable work and work which no other association or body of men can do. On its merits Dr. Hoyt's paper deserved full discussion and it is unfortunate that it failed to receive it. Well, gentlemen! There are twenty-two papers still to be presented and discussed, in addition to a considerable amount of time to be spent on committee reports, elections and other official and miscellaneous matters. What is going to be done about it? It would be absurd and unworthy of the Association, as well as unfair and discourteous to the gentlemen who have prepared papers yet to be presented, to attempt to hurry through all this business in the two short sessions which, in theory, are all that is left of the convention. Will you hold an evening session to-night? Or will you stay over for another day? What will you do? This is a matter which ought to be decided early in the day-the first thing at the morning session, if possible. Then let the sessions come to order promptly and attend strictly to business. So far the sessions have not begun promptly and business has not been expedited. As a result, we are not yet nearly one-half way through the programme. What is to be done about it? To-Day's Programme. 1. Reading of minutes of last session. 2. Report of Committee of Arrangements. 3. Election of Officers-President, Secretary and Treasurer. 4. Report of Committee on Nominations. 5. Report of Judicial Committee. 6. Selection of place of next meeting. 7. Miscellaneous business. 8. "Cardinal Principles in Amputations," by Dr. A. I. Bouffleur, Chicago, Ill. Discussion to be opened by Dr. J. B. Murphy. 9. 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. 10. "Hernia as a Factor in Personal Damage Suits," by Dr. John B. Hamilton, Chicago, Ill. Discussion to be opened by Drs. W. B. Outten and J. B. Murphy. II. "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. 12. "Amputations in the Lower Extremity; How and Where They Should be Performed," by Dr. W. R. Hamilton, Pittsburg, Pa. Discussion to be opened by Drs. W. P. King and S. S. Thorne. 13. "Shock in its Relation to Permanent Injury," by Dr. Thos. O. Summers, St. Louis, Mo. Discussion to be opened by Drs. Rhett Goode and Davis. 14. "The Treatment of Shock," by Dr. Jas. H. Letcher, Henderson, Ky. 15. "The Treatment of Burns," by Dr. E. W. Lee, Omaha, Neb. Discussion to be opened by Drs. F. H. Caldwell and W. R. Hamilton. 16. "Brain Abscess," by Dr. W. A. McCandless, St. Louis, Mo. Discussion to be opened by Dr. E. W. Andrews. 17. "A Case in Practice," by Dr. A. L. Clark, Elgin, Ill. 18. "Medicine and Surgery and Their Votaries of To-day," by Dr. M. E. Alderson, Russellville, Ky. Discussion to be opened by Drs. E. R. Lewis and J. B. Murphy. A. C. Wedge, Albert Lea, Minn. Discussion to be opened by Dr. J. B. Murphy. 4. "Problems and Principles," by Dr. Jabez N. Jackson, Kansas City, Mo. Discussion to be opened by Drs. A. L. Fulton and E. F. Yancey. 5. "Our Problems," by Dr. Thomas H. Briggs, Battle Creek, Mich. Discussion to be opened by Drs. T. W. Miller and S. S. Thorne. 6. "Are We Too Hasty in Amputating in Cases of Compound Fracture?" By Dr. W. S. Hoy, Wellston, O. 7. 'Antisepsis versus Asepsis in Accidental Surgery," by Dr. Jas. T. Jelks, Hot Springs, Ark. Discussion to be opened by Drs. J. B. Murphy and W. B. Outten. 8. "Traumatism of the Hand," by Dr. J. EUGENE R. LEWIS, M.D., KANSAS CITY, MO. Treasurer N. A. R. S. D. Milligan, Cincinnati, O. Discussion to be opened by Dr. J. A. Barr. 9. "Drainage in Surgery," by Dr. W. S. Caldwell, Freeport, Ill. The complimentary excursion given to the members of the National Association of Railway Surgeons and their ladies by Dr. J. B. Murphy yesterday afternoon was a great success. The lake was as smooth as a billiard table and the day was warm and all that could be wished. An ample lunch was served and several professional entertainers were present to entertain the guests. Numerous "BradleyMartins" were made during the afternoon, with the aid of Ozonate lithia water, and everybody had a good time. The boat was crowded nearly to the limit of comfort. IN CONVENTION. A Summary of Second Day's Proceedings of the Tenth Annual Convention. The convention was called to order yesterday by the president at 9:37 a. m. The minutes of the previous session were read by the secretary, and on motion declared approved. Dr. Bouffleur reported that the Association has received a request fom the Commissioner General of the Tennessee Centennial to hold the present meeting there, but this, unfor CASSIUS D. WESCOTT, M.D., CHICAGO, ILL. tunately, came in too late to receive consideration by the Executive Committee. For the Committee of Arrangements, Dr. Bouffleur reported that sleeping car transportation had been secured from both the Wagner and Pullman companies. The action in the revision of the constitution, taken at the last meeting, was read from the minutes by the secretary. The president then referred the matter to the Judiciary Committee. Reading and Discussion of Papers. The first paper of the day was entitled, “Observation Upon and Reasons for a More Complete Physical Examination of Railway Em ployes," by Dr. Henry F. Hoyt, St. Paul, Minn., who said: ABSTRACT OF DR. HOYT'S PAPER. A large majority of railways now operated require tests to be made of the eyes and ears of employes, but this is often left to laymen, and no doubt sometimes imperfectly done. It was a long time before railway managers realized the importance of having men with normal eyes and ears, but they do now, and this part of the examination has come to stay. As nearly as I can ascertain, there are from twenty to thirty trunk lines and over a thousand smaller operated railway corporations or systems in the United States, altogether employing about seven hundred and fifty thousand men. Out of this vast number I believe there are at this time only six system that require what would be termed a complete physical examination of their employes. These are the Baltimore & Ohio, the Pennsylvania East, the Reading, the Burlington, the Pennsylvania West and Plant Systems. These corporations, as I understand it, only require those employes to undergo examination who desire to become members of their respective relief associations, and doubtless the examination is to a large extent due to the fact that there is a relief fund or insurance benefit feature connected with these associations. There are other reasons, however, why every railway corporation should pay more attention to this question. With very few exceptions a man cannot enter into any department of the civil, military or naval service of the government without first demonstrating that he is physically sound and free from disease or its effects, and unless he can do so he is promptly rejected, no matter what his mental attainments may be. Yet how slight is their physical responsibility as a rule compared with that of the average train man on a railway, who can get employment with hardly a thought of his physical condition, be at once put in charge of human lives and property, where in discharge of his duty a pathological or congenital defect may cause great loss of both. After an accident railway companies are prompt in getting reports of the condition of an injured employe, and often in damage suits take the ground that injuries presented existed before accident occurred, but this position is rarely sustained for obvious reasons. A careful, complete physical examination of every man employed in the train or mechanical railway service made and recorded by a competent surgeon will not only elevate the present standard of manhood, strength and physical excellence among employes, but it may often prevent great loss of life and property. A physical defect does not necessarily bar a man from earning his living by railroad work, but these conditions should be known and the unfortunate possessor of defective or diseased eyes, ears or heart, should be absolutely prohibited from filling any position where, in the discharge of his duty, he is, or may in anyway become, responsible for human life. In the way of protection of the traveling public, a physically perfect train crew will certainly minimize the danger in emergencies when compared with an imperfect one. Another reason I advocate physical examination of employes is to protect the corporation against a certain class of unjust claimsfor damages for alleged personal injury sustained while on duty by employes. Some are perhaps made honestly through ignorance, but the majority made by the class I refer to are fraudulent. A man has some form of hernia, a spinal deformity or other pathological or congenital defect. He engages to work for a railway company where there is no physical examination. By watching his opportunity something soon occurs that he can adapt to his case and he is apparently injured. He keeps his bed, has the usual tedious recovery, exasperates the surgeon almost beyond endurance by his unreasonable demands and general cussedness, finally exhibiting the milk in the cocoanut by making an exorbitant demand to the company for his permanent disability, alleged to have been incurred in their service. The claim agent to whom you now cheerfully shift the burden of responsibility, recognizing or suspecting the injustice of his modest request, refuses to settle. He brings suit. The company have now got to prove that he had the infirmity prior to the time of the alleged accident. Under the existing circumstances this proof is next to impossible, and if the company is what is termed in legal phraseology "liable," the result is generally a fat verdict in favor of plaintiff. Dr. Hoyt's paper was not discussed. The next paper was by Dr. H. L. Getz of Marshalltown, Iowa, who gave some "Hints On the Treatment of Fractures of the Humerus, Radius and Ulna, with Complication of the Elbow-Joint." ABSTRACT OF PAPER BY DR. GETZ. I desire to call attention in this paper more especially to the importance and value of early manipulation in the treatment of the injuries named in title, and also to offer suggestions as aids in accomplishing the results most desirable. Three weeks, in what may be termed modern surgery, was regarded as an early date, after time of sustaining injury, to begin even passive movement of a joint involved by fracture, and while the value and importance of early manipulation was then appreciated, there seems to have existed in the minds of surgeons, as it does now doubtless with many, that an earlier manipulation would result in the displacement of the fragments of the injured bones and so interfere with their union. While in the majority of fractures three to four weeks are required to insure a firm union, yet observation and experience have convinced the writer that most of these fractures are sufficiently firm in a week, and some in even less time, to bear reasonable manipulation and motion of the part when protected by the hand of the surgeon over the seat of fracture. For many years it has been my custom in the treatment of these injuries to most carefully note, while reducing the same, the exact seat and character of the fracture, so that in the subse HENRY F. HOYT, M.D., ST. PAUL, MINN. quent early manipulation of the injured member support may be given at the exact point of injury, by the hand of the operator. It is by no means always necessary to use the entire hand in giving the necessary support at the seat of fracture; in fact, the thumb and one or two fingers are usually preferable, in as much as a finer sense of touch is thus obtained and any tendency to displacement of fracture, thus noted and more easily and readily averted; support so made also allows of more freedom of movement of muscles and tendons over the seat of injury than when the full hand is made to grasp the member at point where support is required. In the primary treatment of these injuries it is usually best, especially in children, and in adults where there is perhaps considerable swelling, as is so apt to occur in a short time after receipt of injury at the elbow-joint, so that as already noted above, the exact location and character of the injury may be thoroughly defined; even in the after-treatment by passive motion it is well, especially in children, to use chloroform. I have frequently given a child a comparatively small quantity of chloroform, removed the dressings, manipulated and massaged the parts, reapplied the splints just in time to have the patient awaken and not realize what had transpired; another advantage in the use of an anæsthetic is the relaxation of the muscles and also the avoidance of contraction of muscles from fear of pain. In fracture of the olecranon or of coronoid process, movement, flexion and extension of forearm is best deferred for from ten to fourteen days and then it is necessary to protect carefully the parts, so that separation of surfaces of the broken bone are held in close apposition. In Colles' fracture massage is of much less value and importance, or, in fact, less required than in elbow injuries, because there is a less amount of tissue here liable to inflammation and resulting deposits when movement is commenced. The thumb of one of the surgeon's hands should be placed immediately below inner surface of fracture, and usually the index or middle finger, and sometimes both, over the dorsal surface of wrist or lower part of forearm over the fracture; this done, the fracture is carefully protected and held in place, while the surgeon's other hand grasps the hand of the patient and gently moves the hand upon the forearm once in each direction. This movement, is, however, not of so much value as a full flexion and extension of the fingers and thumb of the hand; that is, flexion and extension of the fingers should be done as far as possible by effort on part of the patient, and should only be aided by the surgeon when the patient is not able to fully flex and extend. It is surprising, indeed, how little support is necessary to hold in position the ends of broken bone while the extension and flexion of the hands and fingers are made; if there coexists Colles' fracture and fracture of the ulna about opposite the seat of Colles' fracture, the fracture in the ulna may be supported by the same hand with which he supports the Colles' fracture, if, however, the seat of fracture in the ulna is higher up, the hand of an assistant may become necessary to give proper support to the ulna. Better than this, however, is the application, temporarily, of a light, short splint to upper and lower side of the arm, which should be held in place by bandage, thus giving the part to be manipulated into the hands of one person. By this method there is less liability of disturbing the broken ends of bone. This movement of the hand and wrist may, with advantage, be commenced in from four to five days after the original treatment (the adjustment of the fracture) and should be repeated every few days for three to four weeks. This plan pursued will give the patient a useful hand and arm in from three to four weeks in many instances, and splints may then be discarded. One manipulation, as I have here suggested, say, even within the first week after receipt of injury, is worth ten or more commenced three weeks or a month after the injury. Summing up, give an anæsthetic, especially in children or timid and sensitive persons, so that you may satisfy yourself of the full nature and location of the fracture, and also that you may completely and properly reduce dislocation, if existing, and adjust the fracture to a nicety. Dress these injuries in such a way that they may be easily examined and manipulated, take them out of these dressing and institute passive and encourage active motion; be not afraid to make these movements. Always tell your patient how much danger there is of a stiff elbow or wrist or impaired use of hand, even under the best of surgical care and treatment, just as you see in most, if not all, of the surgical works to date. If you will practice that which I have suggested in this paper in general and detailed method you will surprise the patient and friends, and, in fact, yourselves, when you compare results with the old methods of treating these injuries, and they will wonder why you ever made such a statement. They will be contented, however, to drop the query at having a good and useful arm or hand, as the case may be, and will accord you a good and skillful surgeon. In conclusion I can assure you that if you will follow these suggestions you will materially reduce the number of malpractice suits. The discussion was opened by Dr. D. S. Fairchild, who said: Fractures of the humerus, or of the radius, or ulna, near or into the elbow-joint, simple, or simple and comminuted, involve propositions of great interest to the general surgeon on account of the deformity and impaired motion which may follow. All the facts connected with these cases are well known and nothing new or specially important can be offered. However, it may be helpful to use to review our present knowledge and experience with the hope of being able to avail ourselves of the best methods employed by those having the largest and best experience in the treatment of these injuries. So much depends upon the care and skill employed in the management of these cases, and so important are the ultimate results to the patient, that no apology need be offered for the time employed in the consideration of fractures of any kind involving important joints. |