the surgeon to ward off danger, even by suturing the visceral and parietal layers of the pleura.

7. A certain number of spontaneous affections of the lung may be successfully dealt with if the surgeon be careful to make a study of symptoms and indications, and a careful selection of his operative measures.

8. Simple and gangrenous abscesses, when they are of limited extent, show no tendency to cure, and threaten life, are amenable to surgical treatment.

9. In such cases the results are almost always favorable.

10. It is advisable to open, scrape, drain and even cauterize tuberculous abscesses of the lung, when these cause severe pain or have resulted in fistula, or contracted extensive adhesions with the pleura.

II. It is often useful in these cases to associate with such treatment partial resection of the ribs.

12. No benefit is likely to result from excision of fragments of the lung surrounding the tuberculous cavities, as the tubercle bacilli have already spread beyond the apparent limit of the disease.

13. It is advisable to open hydatid cysts of the lung, the surgeon taking advantage of adhesions when such exist, and establishing still further adhesions when those existing are not of sufficient extent, in order to be able to wash out the cavity with antiseptic solutions.

14. Solid tumors of the lung should be extirpated when superficial; the occasions, however, for this treatment must be rare, as such growths are almost always secondary.

Treatment of Aseptic Wounds Without Bandages or Dressings.

In the British Medical Journal of February 1, 1896, is a paper by Mr. Mackenzie with the above title. It is summarized in a recent issue of the Annals of Surgery as follows:

The requisites to promote healing of wounds

are:

I. To maintain the parts at rest and the raw surfaces that are intended to unite together in close and constant apposition.

2. To prevent contamination of the wound from external sources.

3. To get rid of excessive discharges. Mackenzie claims that the dressings and bandages usually employed to obtain these ends are expensive, cumbersome, and often insufficient. He closes all wounds, when the incision is made through the skin, by rows of buried sutures of fine catgut and a continuous catgut suture of the skin. A carbolized compress is kept in position a few minutes to absorb any oozing. The surface is then lightly

sponged with alcohol and painted with a layer of celloidin (celloidin one part, absolute alcohol and sulphuric ether each four parts). No other dressing is applied. If the wound has been carefully sutured and is aseptic, there is no discharge. If anything like a stitch abscess occurs, the celloidin can be pricked at the affected point and the drop of pus allowed to escape without disturbing the rest of the suture line. In this way the writer has treated cases of hernia, excision of the breast, amputations of the limbs-in fact, any wound which does not involve mucous membrane. The method especially commends itself in wounds of the face, many of which are perfectly held by the celloidin and require no suture.

A Natural Query.

A Detroit youngster, in his sixth year, had for several months, with all the insistence of a youth of his age, pestered his parents for a bicycle. The other evening his father, in response to the usual plea, suggested it might be well to pray for the desired wheel. Accordingly, at bedtime the youngster's petition was put up, and the following morning, full of faith, he descended to the hall, to view the treasure expected to be there. Sure enough he found a spick-span, brand-new-tricycle!

A look of utter disgust overspread Eddie's countenance. "O God," he said, "don't you know the difference between a bicycle and a tricycle?"-Medical Age.

Report of Standing Committee of the Section of Railway Surgery of the New York MedicoLegal Society on "Car Sanitation and the Railway Transportation of Cases of Contagious and Infectious Diseases."

[From Advance Sheets of Medico-Legal Journal.] To the Section on Railway Surgery of the Medico-Legal Society of New York.

Gentlemen:-The standing committee authorized at the November, 1895, meeting--joint session to report on the question of car sanitation, and especially on the transportation of people, sick or afflicted with infectious or contagious diseases, submit the following report:

Transportation of the sick is necessary.

It is the duty, and to the interest of all, that railway managers consider how best to meet the exigencies of such service, and how best to protect all who travel on railways, from the danger of infection and contagion.

In this report we will first consider tuberculosis, better known as consumption, which is a dangerous, infectious, communicable disease, the spread of which may be largely prevented by isolation, and by simple and easy means of cleanliness on the part of those

afflicted, and those having care of them. It is transmitted in the vast majority of cases, from the sick to the healthy, by means of the sputum or expectoration of those afflicted with the disease.

Apartments, berths, compartments in coaches, etc., which have been occupied by a consumptive, or by a person sick with any contagious disease, should not be occupied by others, until they have been disinfected.

Sick people travel under different circum

stances:

1. Some take passage in an apparently healthy state, and after a few hours experience the first symptoms of infection.

2. Others suffering from an acute transmissible disease, hastily undertake a short journey, in order to reach their family physicians.

3. Others having acquired a chronic disease travel with a theraputic object, in search of a different climate, of a bathing station, etc.

4. The unfortunate incurables often return to die in their own homes, or among their own people.

The sleeping car is considered by all to be the point of greatest danger. Fellow passengers and employes can and should be protected. The question of car sanitation is timely, very important, and of deep interest to the traveling public of the entire world. It is also a very delicate question indeed, for the officials of our railways to consider and settle, for it affects the personal liberty of passengers.

Your committee believes, however, that when our officials fully understand the dangers arising from the present custom of transportation of people sick with contagious diseases, that they will be found ready and willing to meet us in discussion, to receive instructions, and if they can see their way clear, to adopt proper and up-to-date means of prevention.

Your committee also believes that car sanitation is an element soon to be advertised by railways, and in proportion to its perfection, will they receive profit and commendation.

Preventative measures are, in the judgment of your committee, the best means of averting the dangers we are asked to consider. We therefore make the following recommendations:

surgeons.

5.

I. Prevention.-1. Education of the public through the daily press. 2. Legislation, state and national. 3. Isolation of passengers. 4. Disinfection of berths and compartments. A conference between railway men and railway George Chaffe, M. D., Ch'rm., Surgeon; Ex-President N. Y. State Association Railway Surgeons, Brooklyn, N. Y. Clark Bell, Esq., Vice-Chairman and Secretary Section Medico-Legal Surgery, New York City; Frank H. Caldwell, M. D., Chief

Surgeon Plant System of Railways, Sanford, Florida; Granville P. Conn, M. D., Chief Surgeon; Ex-Chairman Section Medico-Legal Surgery; Medico-Legal Society, Concord, N. H.,; B. P. Downs, Surgeon N. Y. & N. H. R. R. R.; Secretary Medico-Legal Congress, Bridgeport, Conn.; R. Sayre Harden, M. D., Surgeon; Ex-President N. Y. State Association of Railway Surgeons, Waverly, N. Y.; J. B. Murdock, M. D., Chief Surgeon; ExPresident National Association Railway Surgeons; Vice-Chairman Section Medico-Legal Surgery, Pittsburg, Pa.; R. S. Parkhill, M. D., Surgeon; President N. Y. State Association Railway Surgeons, Hornellsville, N. Y.; R. Harvey Reed, M. D., Chief Surgeon; Editor American Academy of Railway Surgeons; Editor Columbus Medical Journal, Columbus, Ohio.

Dated April 15, 1896.

A tongue-Congreve said he knew a lady that loved to talk so incessantly she would not give an echo fair play; she had that everlasting rotation of tongue that an echo must wait till she died before it could catch her last words.

While a speaker was describing the nature of gas a blue stocking lady clamorously inquired of a gentleman near her, "what the speaker meant by oxy-gin and hydro-gin, what was the difference?" "Very little, madame," said he, "by oxy-gin we mean pure gin, and by hydro-gin we mean gin and water."

FOR SALE.

PRACTICE FOR SALE:-I offer for sale my practice in the county seat of one of the best counties in Iowa. Have been here for twelve years; am surgeon of the leading road entering the town; am medical examiner for six life insurance companies, etc. I simply require that my successor buy my office fixtures, mostly new-worth $700. Purchaser must be reliable with few years' practice. Address "Z. V.," care RAILWAY SURGEON, Chicago.

Desiring to remove to the Pacific Coast, I offer my well-established practice of over 20 years to any physician who will purchase my real estate, situated in one of the most beautiful and thriving towns in Southern Michigan, and surrounded by a very rich farming country. The town is intersected by two important railroads, for one of which the subscriber is surgeon. The real estate consists of a fine brick house of eight rooms and two fine offices besides, attached to, and a part of, the residence. A fine well of the purest water. two cisterns. waterworks, etc. Fine garden filled with choice fruit in bearing, peaches, pears and apricots and small fruits, raspberries, currants, etc. Fine barn and other outbuildings, comparatively new and in the very best condition, all offered with the practice and goodwill at a very low figure for cash. Address "MACK, Surgeon," care RAILWAY SURGEON, Monadnock Block Chicago, Ill.

By reason of failing health, physician wishes to dispose of real estate and practice. Practice amounts to nearly $4.000 per year. No charges except for real estate. Address W M. D. B. AINEY, Montrose, Pa.

Desiring to remove to a warmer climate, owing to poor health. I offer my well-established practice of 11 years to any physician who will purchase my real estate: situated in one of the most thriving towns in the Platte Valley, in Central Nebraska, on main line of Union Pacific R. R., on which road I am the assistant surgeon.

The real estate consists of 2 lots "on corner." on which there is a fine artistic "modern" frame house, 8 rooms: stable 20x30, wind mill. tower and 30-barrel tank: nice blue grass lawn. trees and fine garden (all new); and all offered with my $5,000 practice and good will, at a very low figure. A part cash, balance on time. A very thickly populated country. Address BOVINE, "care RAILWAY SURGEON, Monadnock Block, Chicago, Ill

white substance which surrounds the axis cylinder, and a thin membrane which encloses the white substance. The axis cylinder is the essential, the transmitting portion of the nerve, and constitutes about one-third to one-half of the nerve fiber In the fresh state it is transparent, but after post-mortem changes, under a high power, it shows fine longitudinal

NO. 1. TRANSVERSE SECTION OF NORMAL NERVE. striations. The white substance of Schwann is apparently made up of fluid fat, and acts as an insulator to the axis cylinder; the white substance of Schwann is interrupted at regular intervals by the nodes of Ranvier. The neurilemma which surrounds and holds in place the white substance of Schwann is composed of nucleated endothelial cells, and, like the axis cylinders, suffers no interruption at the nodes of Ranvier. If we study the formation of nerve cords from nerve fibers, we find that a number of fibers are united into a bundle by connective tissue called the endoneurium. A number of these primary bundles are enclosed by a laminated sheath containing lymph spaces and called the perineurium. Secondary bundles are finally grouped into nerve cords surrounded by connective tissue, the epineurium.

DEGENERATION OF MOTOR NERVE FIBERS AFTER INJURY OR DIVISION.

It has come to be one of the fundamental laws of the physiology and pathology of the nervous system that a nerve fiber, cut off from

its trophic center, degenerates throughout its entire extent. This fact was first demonstrated by Nasse in 1839 and was afterward confirmed by Waller, Budge, Bruck and others. The degenerative process consists essentially in a breaking up of the myeline or white substance of Schwann into drops of fat. The axis cylinders also break up into fragments and both disappear by absorption. This degenerative process is much more pronounced in that portion of a motor nerve distal to the place of section, while the proximal portion, which still retains its connection to the so-called trophic centers, undergoes but little degenerative change. The inception of this process may be seen as early as the fifth day, and is frequently complete by the tenth or fourteenth day.

The tissue normally innervated by a divided nerve also undergoes degenerative changes; the surface temperature falls from 2 to 7 de.grees F. and the part feels cold; in the skin there are burning, pricking pains, formication, increase of sweat or at times abnormal dryness, œdema, redness or abnormal pallor. Such cutaneous affections as eczema, herpes, zoster, pemphigus and echthyma may appear, or disturbances of nutrition with the formation of eschars, ulcerations or gangrene. Inflammatory and trophic disturbances may also take place in the periosteum and bones. In the joints serous effusions may occur, taking the form of chronic hydrarthrosis or plastic exudates with organization producing ankylosis, may appear. These processes in the bones and joints occur only as final results in unhealed nerves. Immediately after division of

servation would seem to demonstrate that if a nerve is immediately sutured after division or in cases of excision, if the interval is immediately bridged over with some suitable porous material, complete degeneration of the entire peripheral portion does not take place. The re-establishment of sensory and motor function, within a few hours or at most days, in a

NO. 3. FLAP METHOD.

considerable number of these cases would seem to prove this. Function is too quickly restored for the regeneration of a completely degenerated nerve. If the sciatic nerve of a dog be divided, the ends will be immediately separated by about an inch, in consequence of the elasticity and contractility of the nerve tissue. If the wound is closed without any attempt being made to unite the divided nerve, and the parts be examined at the end of two weeks, both ends of the nerve will be found bulbous, the proximal bulb being the larger. The distal portion of the nerve will have lost its pearl-like, glistening appearance and will appear dull and sodden, and will have shrunken at least one-third in size. If the nerve be immediately sutured after division, the macroscopic degenerative appearances are much less pronounced, the nerve retaining practically its normal appearance.

REGENERATION OF A DEGENERATED NERVE.

This depends almost wholly upon the approximation or indirect connection of the two ends of the divided nerve. Regeneration always begins in the proximal portion of the nerve, and probably depends upon a strong forward growth of the axis cylinders, which are capable of being projected across a very considerable interval to the distal portion of the nerve if there be a scaffolding of loose tissue to direct them. Reaching the distal portion of the nerve the axis cylinders are directed by the empty nerve sheaths and connective tissue

spaces to the very extremity of the nerve, ending in muscle, skin or gland. At first many of the axis cylinders are naked, but later become surrounded by a myeline sheath. A few investigators hold that nerve regeneration is brought about by a proliferation of the nucleated endothelial cells of the neurilemma, these cells sending out strong offshoots, which become the new axis cylinders. They also hold that the process of regeneration is carried on in both extremities of the divided nerve, though to a less extent in the distal.

SPONTANEOUS REGENERATION OF NERVES WITH

OUT SUTURE.

Clinical experience has demonstrated the possibility of the restoration of the conductivity of nerves after division without suture. The experience of Keen, Weir Mitchell, Morehous, Notta and others, has proven that this condition may occur in exceptional cases. Notta saw an instance of spontaneous regeneration within six months after division of all the nerves of the arm. Tiedmann, in August, 1827, exposed the brachial plexus of a dog in the axilla and divided each nerve, excising from them a piece two to two and a half centimeters long. Complete paralysis of sensation and motion followed, but in the course. of a year and a half both sensation and motion returned. Six months after the return of function, the dog was killed and the nerves found united by medullated nerve fibers. Schiff excised five centimeters of the Vagus nerve in a dog, and after several months demonstrated the restoration of the conductivity of the nerve. Langenbeck and Hueter observed restoration of the conductivity after

NO. 4. BRIDGE OF SILK.

laceration of the brachial plexus in a Prussian officer, who was wounded by a cannon ball in the storming of the Düppeler redoubt on April 18, 1864. In September of the same year the arm was completely paralyzed. After one year and a half the function of the arm was so far restored that the patient became fit for active duty and served as an officer in the campaign of 1866 He was killed