Railway Surgeon DAILY EDITION. Published in honor of the Tenth Annual Convention of the National Association of Railway Surgeons. should be a success. Dr. Riordan, to whose efforts the selection of Toronto is undoubtedly due, can feel that he has satisfactorily accomplished his good mission. The change in the name of the Association from "National" to "International" is entirely right and proper. The Association always has had a considerable membership outside of the United States. It has members now in The Railway Age and Northwestern Railroader (Inc.), Canada, Mexico and the Hawaiian Islands. President. MONADNOCK BLOCK, CHICAGO, ILL. Officers of the N. A. R. S., 1896-7. First Vice President .F. J. LUTZ, St. Louis, Mo. W. R. HAMILTON, Pittsburg, Pa. Second Vice-President...J. H. LETCHER, Henderson, Ky. Third Vice-President.. JOHN L. EDDY, Olean, N. Y, Fourth Vice-President...J. A. HUTCHINSON, Montreal, Canada. Fifth Vice-President. A. C. WEDGE, Albert Lea, Minn. Sixth Vice-President. RHETT GOODE, Mobile, Ala. Seventh Vice-President..E. W. LEE, Omaha, Neb. 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. We do not wish to say too much ourselves about the Daily Railway Surgeon. The convention yesterday, collectively in its vote of thanks, and also individually in the personal expressions of congratulations from innumerable members, has said all that need be said. We believe that the Daily has been of real service to the convention and that fact alone is a sufficient reward for the work which has been put into it, and it is not necessary to say that that work has not been slight. For the additional reward of the vote of thanks and the kind things which have been said of the paper the publishers are grateful. The decision to meet next year at Toronto will meet with the approval of the membership of the Association at large. We have always had a considerable membership in the Association among Canadian surgeons, and they have been untiring in their attendance at the conventions. Even when the convention met at Galveston, which was about as far from the British possessions as it was possible to get in North America, the Canadians were present in force. We understand that the proposition to hold the meeting in Toronto has the support of the Canadian railways, and there is every reason why a meeting there Moreover, members from both Canada and Mexico are present at nearly all the conventions, and both countries are represented at the present meeting. In view of the fact that the next convention is likely to be held in Toronto, the inappropriateness of the term "national" would be next year more conspicuous than ever. We have already referred to the suggestions made by President Lutz in his annual address to the effect that the Association should take up for itself each year some specified topic, and handle that topic thoroughly, instead of scattering itself promiscuously over the whole domain of surgery. Dr. Lutz, at yesterday's meeting, followed up his suggestions made in the address by specifically proposing that next year particular attention be given to the subject of Shock. There could not be a better direction for the best efforts of the Association. During the year committees and sub-committees ought to be at work on different phases of the subject. Individuals best qualified to handle each aspect of the matter should be delegated to prepare papers for next year's convention. Moreover, every individual member of the Association must give his assistance to the committees, and must furnish whatever reports, suggestions or information his experience qualifies him to offer. The matter cannot be left until a month or two immediately preceding the convention, but systematic work must be done on it continuously throughout the year. By next convention we shall have arrived at something of actual scientific value, and next year's convention need not, and should not end the work on this subject. With the information gathered next year as a basis, further investigations should be prosecuted and further conclusions sought during the following year. By pursuing such a course the Association will not only render valuable aid to science and to humanity, but it will make itself recognized as a distinct and definite force in the scientific world. That is what the Association is capable of being and ought to be. It only rests with itself to fulfill its mission. Among the members who registered yesterday was Dr. Kaster, the newly appointed chief surgeon of the Atchison Topeka & Santa Fe. Dr. Kaster has been associated for ten years with the Atlantic & Pacific, which is part of the Santa Fe system, and has the very thorough and whole-hearted regard and affection of the men. Dr. Kaster has a very large system on his hands, but he is thoroughly able to handle it, and under his administration there is no doubt that the hospital department of the Atchison Topeka & Santa Fe will be not only a continued success, but also, we believe, thoroughly popular with the employes of all classes. It is not necessary for us here to say anything in praise of the new officers of the Association. The interests of the Association will be safe in their hands during the year. We have already said in the former issues of the daily paper that the Association is to-day in better condition as a harmonious and workmanlike body than it has ever been. There is a much more earnest intention visible among the members at large to make the Association of real force and value. The officers who were elected yesterday are thoroughly capable of leading in the work, and of giving the right direction to the Association's efforts. In all ways the arrangements made for the convention by Dr. Bouffleur and his colleagues on the Committee of Arrangements were admirable, and in nothing better than in the arrangements made for the accommodation of exhibitors. The exhibitors, moreover, took excellent advantage of the facilities offered to them, and there is no question that the displays of exhibits at this convention were very much better and more interesting than at any former meeting. The exhibits are a feature of the convention which deserve encouragement, as, quite apart from any commercial consideration, they have real and great educational value. IN CONVENTION. A Summary of Third Day's Proceedings of the Tenth Annual Convention. The president called the meeting to order at 9:20 a. m. The minutes of the previous session were read and approved. A communication was read by the secretary from the Detroit Chamber of Commerce, inviting the Association to hold its next meeting in Detroit. The communication was referred to the Committee on Nominations. The first paper of the day was entitled, "Amputations in the Lower Extremity; How and Where They Should be Performed," by Dr. W. R. Hamilton of Pittsburg, Pa. ABSTRACT OF DR. HAMILTON'S PAPER. Railroad surgeons meet with many injured limbs requiring amputation. They cannot take as guides in operating the illustrations given in our systematic works on surgery. The illustrations of modes of amputating in these are of operations performed on the cadaver. The first amputation referred to is that of the ankle-joint. The method adopted by the writer is free from danger, easy of execution and produces a stump that disables the injured in the smallest degree where amputation is performed in the lower extremity. It differs from Symes' method, which is often followed by sloughing of the flap-and mostly produces stumps badly fitted for bearing pressure, and admits of a cheaper and more durable artificial appliance. Chopart's amputation should be abandoned, unless the injured refuses to have the anklejoint amputation performed, or the surgeon feels incompetent to perform it, or in case of double amputation. Pirogoff's amputation should also be abandoned. It was introduced in 1852 on account of the disastrous results following Symes' method of dissecting the flap from the os calcis. Pirogoff's operation adds to the length of the stump and unfits it for the application of an artificial foot. Amputation through the lower third of the leg may be made through uninjured tissue. At and above the middle of the leg doubtful tissue may be left in the flaps and every effort made to preserve four or five inches of the tibia, even employing tissue the vitality of which is very doubtful. In amputation at the knee, unless otherwise indicated, the writer makes an incision, commencing a little below the head of the tibia in a line parallel with it and a corresponding one on the opposite side, and raises the included flap, dissecting all the tissues from the bones, then divides the ligaments close to the tibia, disarticulates and forms a posterior flap, as indications require, being careful not to destroy the incolucrum of the joint, especially in children. If the flaps are not sufficiently long, enough may be taken from the condyles to enable the flaps to meet. Amputation should never be performed at a higher point than is absolutely necessary. In the lower third of the thigh, owing to the fact that there is no direct attachment of the muscles to the femur the stump usually becomes conical. Surgeons should not be guided by incompetent artificial limbmakers who are unable to fit limbs to ankle or knee amputations. The competent can. A drainage tube should never be used in dressing a stump. Metallic sutures should have the perference, and when properly introduced the period of complete healing is greatly diminished. The paper was discussed by Dr. W. B. Outten of St. Louis, who said that we could lay down no fixed rules for amputation at the ankle-joint. The circumstances and the nature of the injury will always determine our action here, as elsewhere. Dr. James H. Letcher of Henderson, Ky., then read a paper on "The Treatment of Shock." ABSTRACT OF DR. LETCHER'S PAPER. He spoke of the importance of making a clear distinction between shock and hemorrhage, which have many symptoms in common, and may accompany each the other, but differing widely in their pathological condition, and hence requiring a different treatment. He believed that the condition in shock was one of stimulation of the general sympathetic system, followed by cardiac weakness, or muscle tire, and was not, as is generally taught, a paresis. He thought the preventive treatment in many cases as important as the curative, and in the management of shock we should remember that it was largely dependent upon the personal equation of the individual. He said that a patient who was going to be subjected to a capital operation should be carefully prepared for same. If time permitted for its sedative effects on his nervous system, put him to bed for several days; if living in a malarial district, cinchonize him, regulate his secretions, don't let him know beforehand the day and hour of operation, don't permit him to see the surgical instruments and other paraphernalia, anææsthetize him while in the bed he is to occupy, give just enough of the anesthetic to answer the purpose and keep him under it as short a time as possible, by being ready to operate at once and being as expeditious as possible consistent with safety; keep patient warm and dry and get him to bed between blankets. He advocated the use of sedatives early-opium in some form-preferably sulphate morphia hypodermically. Inhalations of nitrate of amyl at first appearance of shock, and nitroglycerin in 1-100 grain doses every hour or two for several doses as indicated. Hot water, with or without the addition of salt, he considered one of the most valuable remedies, and to be effective should be thrown with a long tube, high up above the sigmoid flexure, and repeated as often as tolerated, and in an urgent case resort to the intravenous use of the W. R. HAMILTON, M. D., PITTSBURG, PA. saline solution at a temperature of 118 to 120 degrees. Strychnia in doses that would ordinarily be considered toxic had proven one of the most efficient remedies. He advocated the use of dry external heat, not to over stimulation, but to produce a gentle hyperæmic condition of the superficial arteries and arterioles. Alcohol, hot, slightly diluted, no sugar, small, oft-repeated doses, did good in some cases. He merely mentioned digitalis, atropia, sulphuric ether and auto-transfusion. This paper was discussed by Dr. C. B. Stemen of Ft. Wayne, Ind., who resorts to bandaging of the extremities with good results in shock leaving the bandage on for two hours sometimes. Dr. P. Dougherty, Junction City, Kan., resorts to elevation of the extremities to accom plish the same thing. He called attention to the fact that different patients are not equally susceptible to shock. Dr. I. H. Tressel of Alliance, Ohio, does not believe in inversion. Dr. Essex of Murphysboro, has seen excellent results follow the hypodermic injection of morphia and alcohol and uses alcohol baths. Dr. Lane of Kansas emphasized the remark made yesterday that the chief need in shock is physiological rest. Dr. Hance of Quincy, Ill., does not believe A. C. WEDGE, M. D., Vice-President N. A. R. S. in bathing in alcohol, because it robs the patient of heat. He injects small doses of alcohol and morphia. Dr. Boyle of Kansas uses alcohol externally with apparent good results. Dr. Getz of Marshalltown, Ia., thinks the external use of acohol useless. Dr. A. L. Cory of Chicago thinks the worst cases we have to manage are those who have been dosed with alcoholics before we get them. Dr. Gould of Indiana called attention to the value of heat over the region of the heart. The next paper was entitled, "The Treatment of Burns," and was read by Dr. E. W. Lee of Omaha, Neb. ABSTRACT OF DR. LEE'S PAPER. The treatment of burns should consist, first, of relieving shock and pain by the administra tion of anæsthetics, opium and strychnia, placing the injured part, or whole body if required, in a bath, while clothing, dirt, etc., are being removed. All blebs and necrotic tissues should be removed, and then, after getting the wound in as nearly as possible an aseptic condition, applying to the raw surface rubber tissue or Lister's protective, and over all an antiseptic dressing. I discourage the use of ointments, oils and powders, except in very superficial burns. For chemical convenience I divide burns into three degrees, according to the depth of tissues involved. Amputations in case of burned extremities should never be made until a line of demarcation is formed. Many deaths following burns are due to the absorption of ptomaines originating in the burned tissue, which could be prevented by removing all necrotic tissue. The great pain and general discomfort following the ordinary application of oils, ointments and powders on burned wounds is prevented by applying rubber tissue. Such a dressing does not "get dry and stick," granulations are promoted and the wound placed in good condition for grafts. This paper was discussed by Dr. Hamilton of Pittsburg, Pa., who said he has never been able to keep burns in an aseptic condition. He uses a mixture of chloroform one part and castor-oil three parts as an application to superficial burns, especially of the face. It relieves pain and promotes healing. Dr. Thompson of Tama, Ia., advocates moist heat as an application in burns. Dr. J. B. Murphy of Chicago asked how long we should allow burns of the second and third degree to go without grafting. He advocates immediate action, or at least within six weeks. He also thinks that at least onehalf of the thickness of the derma should be included in the grafts transferred. He also believes that we should be more thorough in the removal of all cicatricial tissue from the base of the burn before making the graft. Dr. Lee in closing, said that such a dressing as he uses is always easily removed, and often renders subsequent skin grafting un necessary. The next paper was on "Traumatic Brain Abscess," by Dr. W. A. McCandless of St. Louis, Mo. It was an excellent paper and we are sorry not to be able to publish an abstract of it. It was fully discussed by Dr. E. W. Andrews, J. B. Murphy, S. S. Thorn, B. M. Ricketts, Milton Jay and the essayist. The Association then listened to the report of the Legislative Committee, which was read by Dr. Jackson. Dr. C. B. Stemen moved the adoption of the report as read. The motion was seconded and prevailed unanimously. The report related to the new constitution and by-laws, which we cannot publish in this issue for lack of space, but it will appear in our next regular issue. The report of the Committee on Nominations was read by Dr. W. R. Hamilton, and was adopted. It was as follows: Your Committee on Nominations would make the following recommendations: For vice-presidents: Dr. J. Alex. Hutchinson, Montreal, Can. Dr. W. Q. Marsh, Sierra Mojada, Coah, Place of meeting, Toronto, Canada. Executive Committee: Dr. W. B. Outten, St. Louis, Mo. Dr. Jas. H. Letcher, Henderson, Ky. The committee also named as delegate from this Association to the British Medical Association, to meet in Montreal, Can., in August, Dr. Frank J. Lutz of St. Louis, and recommend that he receive a proper certificate with the seal of the Association affixed. Dr. Murphy moved that Dr. W. S. Caldwell of Illinois be given credentials as a delegate to the Moscow meeting. Carried. A member moved the substitution of Richmond in the place of Toronto, Can., as the next. place of meeting. The question on the adoption of the report of the committee with the amendment to substitute Richmond for Toronto, Can., as the next place of meeting, was put and lost. Dr. Hamilton moved that credentials be given all who desire to go as delegates to the Moscow meeting. The question on the adoption of the amendment to give credentials to those who desire to attend the Moscow meeting as delegates from this Association was put and carried. The question on the adoption of the report of the Committee on Nominations was then put and carried. The Association then proceeded to the election of president. Dr. S. S. Thorn nominated Dr. George Ross of Richmond, Va. Dr. McCloskey put in nomination Dr. C. B. Stemen of Fort Wayne, Indiana. The first ballot resulted in 106 votes for Dr. Ross and 61 votes for Dr. Stemen. Dr. Stemen then moved that the election of Dr. Ross be declared unanimous by a standing vote, which prevailed. Dr. Stemen and Dr. Jack |