sion by depressed bone or irritation produced by sharp osseous spiculæ, for often none of these exist, as for instance in such fissured, undepressed fractures with imprisoned hairs, as I have already mentioned, but to secure disinfection and drainage, if disinfection cannot successfully be effected. Immediate danger to life from a broken skull does not reside in the mere injury to the osseous tissue, the depressed spicule of the same, or the lacerated brain substance, unless the latter involves centers essential to life, but from infection. Doubtless infection is more likely to prove effective if the vitality of the encephalic contents is lowered by the damage inflicted by the continued pressure of bone spiculæ or a foreign body, but unless infection has occurred recovery will ensue. The opportunity for disinfection by the removal of infected bone fragments, hairs, and foreign bodies, with drainage in case the efforts at disinfection fail, are the real indications for trephining in compound fractures, and not to do so is a serious "sin of omission" which such teachings as I have been combatting tends to perpetu

ate.

"The late headaches from dural irritation, epilepsies, insanity and other sequelæ of compound fractures are additional and valid reasons for immediate prophylactic trephining in all such cases. If neither depressed bone, spiculæ or infected foreign bodies be removed, no harm should result from a properly conducted operation, but in the vast majority of instances some or all of these conditions exist and will be only remediable by operation."

The Sterilization of Catgut.

At a recent meeting of the Berlin Medical Society Saul (Wiener Klinische Rundschau, 1896, No. 9, p. 154) described a method of sterilizing catgut by means of boiling alcohol, that he has found efficacious and satisfactory. A combination of alcohol 80 parts carbolic acid 5 parts, and water 15 parts effected the purpose best. Hofmeister (Centralblatt für Chirurgie, 1896, No. 9, p. 193) has employed the method of Saul, but failed to secure satisfactory results. His own method consists in first hardening the crude catgut, wound upon rolls, by immersion for twenty-four hours in a 4 per cent. solution of formalin; then boiling in water for ten minutes, and subsequent hardening and preservation in alcohol, to which have been added 5 per cent. of glycerin and one-tenth per cent. of mercuric chlorid.Medical News.

Physicians, when they have found out the cause of a disease, consider they have found out the cure.-Cicero.

Notes of Societies.

Association of Erie Railway Surgeons.

The annual meeting of the Association of Erie Railway Surgeons will be held at the Kent House, Lakewood, N. Y., on September 21, 1896. Matters of great importance are to come before the association, one of which is the relief and hospital system for disabled railroad men, which will be presented to the association by Chief Surgeon C. M. Daniels.

Mr. E. B. Thomas, president of the Erie Railroad System, has accepted an invitation and will be present at this meeting. Surgeon F. J. Lutz, president of the National Association of Railway Surgeons, and W. B. Outten, chief surgeon M. & P. R. R., St. Louis, have both promised to be present. Dr. J. B. Murphy of Chicago has promised also to attend.

There will be a larger attendance, and for several reasons a more interesting session than at any previous one.

John L. Eddy, M. D., Olean, N. Y.,

President. W. W. Appley, M. D.. Cochecton, N. Y., Secretary.

Medical Society of the Missouri Valley.

The ninth annual session of the Medical Society of the Missouri Valley will be held at Council Bluffs, Ia., September 17, 1896. Headquarters, the Grand Hotel, Pearl Street and First avenue; place of meeting, "League Room," Grand Hotel. The following is the scientific programme:

1. "Something About Instrumental Labor," Dr. F. Damour, Bolckow, Mo.

2. "A Case of Anterior Dislocation of the Head of the Radius," Dr. G. W. Boot, Hartley, Ia.

3. "Operative Technique in Appendicitis," Dr. C. C. Allison, Omaha, Neb.

4. "Skin Grafting, a New Method," Dr. J. W. Kime, Des Moines.

5. "A Case of Chronic Pharyngitis Simulating a Tumor," Dr. F. W. Dean, Council Bluffs. 6. A Case-Title Not Given, Dr. J. M. Barstow, Council Bluffs.

7. "Treatment of Burns of Conjunctiva,” Dr. D. C. Bryant, Omaha.

8. "Breech Presentations," Dr. A. D. Wilkinson, Lincoln, Neb.

9. Two Cases (1) "Gastrorrhaphy for Dilatation of the Stomach and Ptosis of the Transverse Colon; and (2) “A Successful Gastro-enterotomy with the Murphy Button," Dr. J. E. Summers, Jr., Omaha.

10. "Treatment of Hydro-Thorax and Empyema." Dr. J. M. Emmert, Atlantic, Ia.

11. "Congenital Dislocation of the Hip," Dr. B. B. Davis, Omaha.

12. A paper-title not given, Dr. R. Hanna, Red Oak, Ia.

13. "Retrogade Catheterization," Dr. A. F. Jonas, Omaha.

14. "Mental Dynamics and Psycho-Therapeutics," Dr. W. B. Lawrence, Red Oak, Ia. 15. "An Instructive Case of Labial Cyst," Dr. R. M. Stone, Omaha.

16. "Typhoid Fever," Dr. M. C. Christensen, Council Bluffs.

17. "Remarks on Appendicitis," Dr. F. W. Porterfield, Atlantic, Iowa.

18. "Meningocele"-with Report of Case, Dr. J. P. Lord, Omaha.

19. “Pulmonary Tuberculosis; Etiology," Dr. C. Engel, Aspinwall, Ia.

20. "A Case of Gunshot Wound of Rectum," Dr. V. L. Treynor, Council Bluffs.

The B. & 0. Railway Surgeons' Association.

The semi-annual meeting of the Baltimore and Ohio Association of Railway Surgeons was held in Philadelphia, June 23, 24 and 25, at the Hotel "Hanover." The committee of arrangements had very wisely prepared the various parts of the programme, so that ample time was given to the reading of all the papers and their free discussion. The intervening time was taken up with interesting and instructive clinics at several of the city hospitals.

The meeting was called to order at 8:30 p. m., June 23, by President J. M. Spear of Cumberland, Md. Papers were read that evening and the following day by Charles A. Oliver, M. D., Philadelphia, "A Clinical Study of the Ophthalmic Symptoms in a Case of Fracture of the Anterior Portion of the Base of the Skull." W. E. Slathers of Wheeling, W. Va., "Fractures." B. J. Byrne, M. D., Ellicott City, Md., "Treatment of Fracture of the Olecranon," read by the secretary. C. M. Frissell, Wheeling, "A Case of Mal-Practice brought Before the West Virginia Courts. In this case the defense is utterly deprived of all chance to defend, on account of the rejection of all professional testimony. Dr. Charles A. Oliver read a paper on "Some of the Inefficiencies of the Methods Commonly Employed by Railway Surgeons for the Detection of Subnormal Color-Perception." J. M. Thorne, M. D., of McKeesport, Pa., read a paper on "The Proper Amputation, with Reference to the Adjustment of Artificial Limbs." Dr. J. J. Hamilton of La Paz, Ind., read a short article on "Tablets and Tablet-Making." Dr. W. L. Dick, Columbus, O., read a paper on "Shock or NeuroParalysis.

The discussions on the several papers were conducted in a very spirited manner throughout, which lent much to the interest of the several sessions of the association. An amendment to the constitution was introduced,

to be acted on at the next meeting, changing the meetings of the association from semi-annual to annual meetings.

The committee on necrology reported the death of three members of the association during the past year: Drs. T. F. Barton, D. P. Aldrich and T. C. Martin.

The following were elected to membership: L. G. Thacker, M. D., Defiance, O.; W. S. Powell, M. D., Defiance, O.; M. Campbell, Parkersburg, W. Va., J. W. McDonald, M. D., Benwood, W. Va.; Charles A. Oliver, M. D., Philadelphia, Pa.; J. A. Ellegood, Wilmington, Del.; W. A. Shuey, Piedmont, W. Va.; G. B. Masters, Rockwood, Pa.; W. M. Dealty, Newark, O.; H. G. M. Kollock, Newark, Del. All the various sessions of the association were well attended and the interest in the work was attentive and at times quite enthusiastic, so that all who took this pilgrimage to the City of Brotherly Love could feel themselves fully repaid. Not the least interesting part of the programme was the flying visit made by many of the members with their wives to Atlantic City. The next meeting will be held in December at Chicago.

J. A. M. Kean, Secy. The papers read at the above meeting will be published in future issues of The Railway Surgeon.

Mississippi Valley Medical Association.

President, H. O. Walker, M. D., Detroit, Mich.; 1st vice-president. B. Merrill Ricketts, M. D., Cincinnati, O.; 2nd vice-president, W. F. Barclay, M. D., Pittsburg, Pa.; secretary, H. W. Loeb, M. D., St. Louis, Mo.; treasurer, H. N. Mover, M. D., Chicago.

Executive Committee: W. T. Belfield, Chicago, Ill.; C. S. Cole, New York, N. Y.; Geo. J. Cook, Indianapolis, Ind.; I. N. Love, St. Louis, Mo.; J. M. Mathews, Louisville, Ky.; A. M. Owen, Evansville, Ind.; C. A. L. Reed, Cincinnati, O.: X. C. Scott, Cleveland, O.; R. Stansbury Sutton, Pittsburg, Pa.; W. N. Wishard, Indianapolis, Ind.

Judicial Council: W. N. Wishard, Indianapolis, Ind.; T. E. Holland, Hot Springs, Ark.; A. P. Buchanan, Ft. Wayne, Ind.

Chairman Committee of Arrangements, C. A. Wheaton, St. Paul, Minn.

Headquarters, Windsor Hotel, St. Paul,

Minn.

At St. Paul, September 15, 16, 17, 18, 1896:

PRELIMINARY PROGRAMME.

President's Address, H. O. Walker, Detroit,

Mich.

Harold N. Moyer, Chicago, Ill., "Address on Medicine."

Horace H. Grant, Louisville, Ky., "Address on Surgery."

I. A. Abt, Chicago, Ill., "The Clinical Significance of the Child's Fontanelle."

W. W. Allison, Peoria, Ill., "Proprietory Prescriptions."

Truman W. Brophy, Chicago, Ill., “A New Operation for Cleft Palate."

Carl Barck, St. Louis, Mo., "Some Rarer Forms of Keratitis."

A. C. Bernays, St. Louis, Mo., "The Results of Operations per se in Cases of Tubercle and Cancer."

S. S. Bishop, Chicago, Ill., "Mastoid Diseases; Their Medical and Surgical Treatment."

J. H. Buckner, Cincinnati, O., "Rupture of the Choroid Coat."

Eduard Boeckmann, St. Paul, Minn., "Operative Treatment of Pterygium."

Gustavus Blech, Detroit, Mich., "Treatment of Some Inflammatory Diseases of the GastroIntestinal Tract."

Gustavus Blech, Detroit, Mich., "Kola."

R. H. Babcock, Chicago, Ill., “A Report of a Case Illustrating the Value of Secondary Physical Signs in the Diagnosis of Cardiac Diseases."

B. M. Behrens, Minneapolis, Minn., "Rhinoscopic Examinations in General Practice."

Guido Bell, Indianapolis, Ind., "Irregularities in Delivery Due to Short Umbilical Cord." A. H. Cordier, Kansas City, Mo., "GastroJejunostomy in Gastrectasis."

Ephraim Cutter, New York, "Conventional Treatment of Heart Disease versus Positive Treatment."

J. Homer Coulter, Chicago, Ill., "Tonsillotomy by Means of the Cautery Blade." Discussion opened by H. W. Loeb, St. Louis, Mo.

G. I. Cullen, Cincinnati, O., "The Newer Remedies in Otology and their Results."

M. F. Cupp, Edinburg, Ind., "Infant Feeding; the Anti-dyscrasic Action of Cow's Milk." W. S. Caldwell, Freeport, Ill., "Ether and Chloroform, their Comparative Merits as Agents for the Production of General Anæsthesia."

J. H. Dunn, Minneapolis, Minn., “Appendicitis; to Operate or Not to Operate."

C. Travis Drennan, Hot Springs, Ark., "Syphilis as an Aetiololical Factor in the Production of Tabes Dorsalis."

J. O. DeCourcey, St. Libory, Ill., “Preventive Medicine."

Arthur R. Edwards, Chicago, Ill., "Certain Misconceptions Regarding Cardiac Murmurs and Their Significance."

J. Frank, Chicago, Ill., "A New Method of Fastening the Broad Ligament in Alexander's Operation."

Alex Hugh Ferguson, Chicago, Ill., "Choledochotomy in America with the Report of Four Cases."

G. Futterer, Chicago, Ill., "Pleuritic Effusions and Their Treatment."

A. Goldspohn, Chicago, Ill., "Rational Operations for the Cure of Retroversions and Flexions."

Augustin H. Goelet, New York, Paper. E. M. Houghton, Detroit, Mich., "A Demonstration of the Therapeutic Action of Antitoxins."

Henry Hatch, Quincy, Ill., Paper.

R. C. Heflebower, Cincinnati, O., Paper. Florence W. Hayes, Terre Haute, Ind., "Stirpiculture."

James B. Herrick, Chicago, Ill., “On the Importance of Physical Signs Other than Murmur in the Diagnosis of Valvular Diseases of the Heart."

C. H. Hughes, St. Louis, Mo., "Honorary Fellow of the Chicago Academy of Medicine The Neural Factor in Clinical Medicine."

Talbot Jones, St. Paul, Minn., "The Value of Medicinal Antipyretics in View of Newly Acquired Knowledge Respecting the Nature of Acute Infectious Diseases."

J. T. Jelks, Hot Springs, Ark., “Treatment of Syphilis."

Elmer Lee, Chicago, Ill., "The Physiologic Treatment of Typhoid Fever."

Bransford Lewis, St. Louis, Mo., Paper.

F. F. Lawrence, Columbus, O., "The Pathology and Treatment of Suppurative Salpyngitis."

I. N. Love, St. Louis, Mo., Paper.

A. H. Meisenbach, St. Louis, Mo., Paper. L. Harrison Mettler, Chicago, Ill., "The Lumbar Enlargement of the Spinal Cord."

J. B. Murphy, Chicago, Ill., "Indications for and Demonstrations of Removal of the Gasserian Ganglion."

Wm. J. Mayo, Rochester, Minn., "The Surgical Treatment of Pyloric Obstruction."

Thos. H. Manley, New York, "Conditions which may Simulate Organic Obstruction of the Rectum."

H. P. Newman, Chicago, Ill., "Multiple Operations in Pelvic Disease."

"A. J. Ochsner, Chicago, Ill., "Nerve Sutures and Other Operations for Injuries to the Nerves of the Upper Extremities."

N. H. Pierce, Chicago, Ill., "Submucous Linear Cauterization; A New Method for Reduction of Hypertrophies of the Conchae."

Paul Paquin, St. Louis, Mo.. "The Treatment of Experimental Tuberculosis in Animals by the Use of Blood Serum."

Frederick Peterson, New York, "The Pathology of Idiocy."

Curran Pope, Louisville, Ky., "Chorea." Hugh T. Patrick, Chicago, Ill., "ElectroDiagnosis and Electro-Therapeutics Simplified."

"Hugh T. Patrick, Chicago, Ill., "Trunk Anæsthesia in Locomotor Ataxia."

Oxygen in Chloroform Narcosis."

H. O. Pantzer, Indianapolis, Ind., Paper. D. C. Mamsey, Mt. Vernon, Ind., "My Favorable Experience with Diphtheria Antitoxin." Byron Robinson, Chicago, Ill., "The Physiology of the Peritoneum from Experiments." Leon Straus, St. Louis, Mo., "Some Fads and Fallacies of Modern Rectal Surgery."

R. Stansbury Sutton, Pittsburg, Pa., "Pregnancy Complicating Operations on the Uterus and its Appendages. Remarks with Cases." A. E. Sterne, Indianapolis, Ind., "The Significance and Occurrence of Capillary Pulsation in Nervous Diseases."

E. W. Sanders, St. Louis, Mo., "Twentyseven Cases of Croup."

E. B. Smith, Detroit, Mich., "The Necessity of Vivisection."

J. H. Taulbee, Mt. Sterling, Ky., "Gunshot Wound of the Liver; Report of Case Involving Diaphragm and Lung; Operation Successful but Fatal Termination Two Weeks later from Pneumothorax."

Fenton B. Turk, Chicago, Ill., "Further Report on the Treatment of 500 cases of Gastritis." (Demonstrations.)

Ferd C. Valentine, New York, "The Rapid Cure of Gonorrhoea."

Weller Van Hook, Chicago, Ill., “Some Unusual Cases of Appendicitis."

K. K. Wheelock, Ft. Wayne, Ind., "Mastoidectomy in Caries of the Temporal Bone."

W. E. Wirt, Cleveland, O., "A Further Contribution on the Use of Dry Heat in the Treatment of Chronic Joint Affections.

Casey A. Wood, Chicago, Ill., "A Further Contribution to the Ocular Treatment of Epilepsy."

D. S. Maddox, Marion, O., "The Decadence of the General Practitioner and the Reign of the Specialist."

RAILROAD ARRANGEMENTS.

The various passenger associations have granted a round trip rate of one and one-third fare on the certificate plan. Those who desire to attend should obtain receipts for the amount paid for tickets (of members and their families) to St. Paul. These receipts must be presented to the secretary, Dr. H. W. Loeb, upon arrival in St. Paul. The return trip must be made within three days after the close of the meeting; however, the time will be extended for those who take the Yellowstone excursion. By special arrangement, the Burlington route will place at the disposal of those who desire to go from St. Louis, or through St. Louis, a well appointed sleeper, leaving St. Louis at 11:50 a. m., Sunday, September 12, and Monday, September 13, and arriving in St. Paul Monday and Tuesday morning. Reservations may be made at any time.

D. C. B. Fry has been appointed chief surgeon of the Peoria, Decatur and Evansville, with headquarters at Mattoon, Ill., vice Dr. G. M. Young, resigned.

Post Graduate Medical School of Chicago Moves.

The Post Graduate Medical School of Chication, at 2400 Dearborn street, September 1, cago moved into its new building and new lo1896. The new building is an ornate structure seven stories in height, constructed as a clinical school and a clinical hospital. The school is complete, having the most modern lecture rooms and laboratories. The hospital has accommodations for 100 beds. One floor is artistically furnished for private patients. There are four operating rooms of the most modern construction, including an amphitheater operating room which will accommodate 300 students. The building is lighted with electricity and is provided with elevators. The new location is at 2400 Dearborn street (Dearborn and Twenty-fourth street). This is selected because of its superior clinical advantages. Within a distance of 10 minutes' ride from the school proper are the St. Luke's, Charity, Michael Reese, Mercy, Woman's and Wesley hospitals. Clinical instruction will begin in the new quarters at once.

Abdominal Section by Cow's Horn.

Skilling (Amer. Jour. Obstet., July, 1895) records a case in which this accidental operation was performed without a fatal result in a non-pregnant woman. The injury is of interest in relation to well-known instances of succesful cesarean section carried out in the same manner. Skilling was called in shortly after the accident. The patient lay in bed, her clothing saturated with blood. Her countenance was anxious and pale, but there was only slight evidence of impending shock. The cow's horn had entered the abdomen just above the symphysis, a little to the right of the median line, and ran obliquely to the right, making a rent six inches long. The peritoneum was involved; the intestines protruded; loss of blood was relatively trifling. The intestines were replaced, the peritoneum closed by a continuous suture of fine silk, and the remaining layers of the parietes by interrupted silk sutures. The wound healed almost throughout by first intention except at the lower angle, where slight suppuration took place, probably from unavoidable contamination with dirt during or after the accident. Recovery was rapid and complete.British Medical Journal.

The Modern Treatment of Burns.

BY HENRY J. KELLY, M. D.,

Lecturer on Surgery, New York Polyclinic.

When we find suppuration, putrefactive decomposition of discharges, and sloughs, with the attendant septic fever, commonly accepted as necessary accompaniments of the healing process in wounds caused by burns, and that indifferent rags soaked in carron oil is a favorite dressing for such cases, it would seem that the methods successfully employed to prevent infection in other wounds are looked upon as of no avail when applied to burns.

This acceptance of infection as a necessity in these cases is all the more singular when we consider that a burn, because produced by a high degree of heat, is always primarily an aseptic wound. Could we maintain this condition of asepticity not only would we spare our patient the dangers of a septic process, but we would prevent his becoming the source of disgusting odors very evident to the surgeon during the change of dressings.

In the case of surface wounds caused by burns, i. e., wounds having no pockets or cavities to drain and being essentially aseptic in origin, are we not justified in the belief that a plan of treatment which would prevent infection in other classes of surface wounds would be equally successful? My own experience leads me to believe that in so far as we are able in any given case to practically apply the principles upon which success depends, in so far will we be able to maintain an aseptic condition during healing. There will be no putrefaction of sloughs or discharges, no fever, and in thoroughly successful cases the discharges will not be purulent; of course, where the vitality of tissues is destroyed, sloughing cannot be prevented, but a slough free from infection is not only inodorous but is a quite harmless foreign substance and not a septic focus.

The dry dressing of wounds, which has been recommended for burns, is a method which has been more or less in use for some time and which aims to prevent infection or the development of germ activity by desiccation of the surface and discharges, the bacteria being thus deprived of the moist field necessary for their propagation.

This dryness of the wound may be secured by the use of dusting powders, plain or antiseptic, or by the use of gauze or other materials in dressings which allow of evaporation.

The usefulness of this form of dressing, in wounds from burns, must be very limited, various reasons existing for its failure prac

condition of the wound cannot be maintained and infection occurs; again, certain antiseptic powders cannot be used on large surfaces owing to their liability to cause toxic effects. And where protection of the surface against contact has necessitated the use of gauze dressings, the pain on removal of the tightly adherent material from the raw surface is enough to compel one to abandon their use. The fatal objection, however, is the failure of this method to maintain asepsis.

The method of dressing which in my hands has given the best results is one for which no originality is claimed, it being simply the moist dressing so generally used in surgery, somewhat modified to fit it to the practical necessities of the case in burns. The materials are all easy of procurement, are easily sterilized or impregnated with antiseptics if required, and are easy of application.

The dressing is most efficient in controlling or at least mitigating sepsis, is comfortable to the patient when applied, and its removal is absolutely painless.

These advantages are sufficiently decided to warrant a rather minute attention to details since in that rigid attention will be found to lie the success of the method.

It would not seem from my own experience that the use of antiseptics was of as much service as thorough asepsis, for in cases where the extent of the burned surface was such as to preclude the use of strong solutions, the results have been satisfactory.

In a burn of moderate severity, when the kidneys are sound and the patient not an alcoholic, what shock is present will most probably be slight, and will be well controlled by the injection of a full dose of morphia; this will also help to obtund the sensibilities. during the dressing, the first step of which must be a thorough preparatory cleansing of the wound and its vicinity. If the wound be recent and we have no especial reason to believe infection has already occurred, corrosive sublimate solutions may be altogether omitted and sterile water or Thiersch's solution used in large quantity, or weak solutions of bichloride (not stronger than 1-3,000) may constitute the first washing, the wound being afterward douched with sterile water or borosalicylic solution. The use of sterile water at a temperature of 110 degrees F., to which sufficient sodium chloride has been added to make the normal salt solution (a heaping teaspoonful to a quart of water), will be found less irritating to the patient that plain water; this must be used in large amounts, thorough and repeated flushings of the surface being advisable, and is a most efficient means of cleansing the wound.

In burns already infected, and where suppuration has been established, it is safer to use a