Notes of Societies.

The French Surgical Association will hold its tenth annual meeting in Paris during the week ending October 24, 1896, under the presidency of Professor Terrier. The two subjects for set discussions are "The Surgical Treatment of Clubfoot," to be opened by M. Forgue of Montpelier, and "The Treatment of Prolapse of the Genital Organs," to be opened by M. Bouilly of Paris. The secretary-general of the association is M. Lucien Picqué, No. 8 Rue de l'Isly, Paris.

The American Public Health Association will hold its twenty-fourth annual meeting at Buffalo, September 15 and 18. The following are the subjects proposed for discussion: The pollution of water supplies; the disposal of garbage and refuse; animal diseases and animal food; the nomenclature of diseases and forms of statistics; protective inoculations in infectious diseases; national health legislation; the cause and prevention of diphtheria; causes and prevention of infant mortality; car sanitation; the prevention of the spread of yellow fever; steamship and steamboat sanitation; the transportation and disposal of the dead; the use of alcoholic drinks from a sanitary standpoint; the centennial of vaccination; the relation of forestry to public health; transportation of diseased tissues by mail; river conservancy boards of supervision.

The American Electro-Therapeutic Association.

The sixth annual meeting of the American Electro-Therapeutic Society will be held in Allston Hall, Boston, Mass., September 29 and 36, and October 1, 1896.

Dr. Robert Newman, New York, president; Dr. R. J. Nunn, Georgia, treasurer; Dr. Emil Huel, 352 Willis avenue, New York, secretary; Prof. A. E. Dalbert, Tuft's College, Mass., chairman of the committee of arrangements. The following is the scientific program:

Address of the President, Dr. Robert Newman, New York City, "The Want of Education in Electro-Therapeutics in Medical Colleges.'

REPORTS OF COMMITTEES ON SCIENTIFIC
QUESTIONS.

"On Induction Coils and Alternators," Mr. A. E. Kennelly, Philadelphia, Pa.

"On Meters," Dr. M. A. Cleaves, New York Citv.

"On Static Machines and Condensers," Dr. W. J. Morton, New York City.

"On Constant Current Generators and Controllers," Dr. W. J. Herdman, Ann Arbor, Mich.

"On Electrodes," Dr. C. R. Dickson, Toronto, Canada.

"On Electric Light Apparatus for Diagnosis and Therapy," Dr. J. H. Kellogg, Battle Creek, Mich.

PAPERS.

"What Can be Done by Means of the Use of Electricity to Avoid Surgical Operations,' Dr. G. Betton Massey, Philadelphia, Pa.

"Electricity in Chronic, Non-Suppurative Affections of the Uterine Appendages," Dr. F. Shavoir, Stamford, Conn.

Discussion by Dr. G. Betton Massey, Philadelphia, Pa.

"Electricity in the Treatment of Diseases of the Throat and Nose," Dr. O. B. Douglass, New York City.

"Electricity in the Treatment of Diseases of the Larynx," Dr. W. C. Phillips, New York City.

'Accidents and Risks in the Use of Street Currents. How Far are They Practicable and Safe in the Use of Electro-Therapeutics?" Mr. J. J. Carty, E. E., New York City.

Discussion by Mr. John J. Cabot, E. E., Cincinnati, O.

"Accidents and Risks in Using Electricity, Generated at Central Stations and Transmitted Over Underground and Overhead Wires to Operators in Electro-Therapy."

"Danger to Patients and Operators and How Prevented. Also Liability of Physicians Using the Same," Mr. John J. Cabot, E. E., Cincinnati, O.

"Experiments Upon the Effects of Direct Electrization of the Stomach," Dr. Max Einhorn, New York City.

"Electricity in Diseases of the Stomach," Dr. David D. Stewart, Philadelphia, Pa. "The Static Current in the Post-Apoplectic State," Dr. John Gerin, Auburn, N. Y.

Lecture I: "The Electrical Principles Generally Used in Medical Treatment," Prof. William L. Puffer, Boston, Mass.

Lecture II: "The Relation of Physics to Physiology," Prof. A. E. Dolbear, Tuft's College, Mass.

"Electro-Therapy in the Treatment of the Nervous," Dr. W. S. Watson, Fishkill-onHudson. N. Y.

"The Role of Electricity in the Treatment of Uric Acid Diathesis," Dr. J. G. Davis, New York City.

"Some Observations in Electro-Therapeutics," Dr. D. R. Brower, Chicago, Ill.

"The Physics of the Production of the XRays," Mr. Edwin Houston, Ph. D., Philadelphia, Pa.; Mr. A. E. Kennelly, F. R. A. S., Philadelphia, Pa.

"Treatment of Strictures by Electrolysis versus Any Other Treatment," Dr. F. H. Wallace, Boston, Mass.

"The Newman Method of Urethral Electrolysis." Its advantages and reasons why some operators fail. Dr. Francis B. Bishop, Washington, D. C.

"Faradism in Gynæcology," Dr. R. J. Nunn, Savannah, Ga.

"The Motor Dynamo-Adapted to ElectroTherapeutic Work," Dr. W. J. Herdman, Ann Arbor, Mich.

Discussion by Mr. Edwin W. Hammer, E. E., New York City, and Dr. G. J. Englemann, Boston, Mass.

"The Application of Electricity to Surgery," Dr. J. W. Herdman, Ann Arbor, Mich.

"A Summary of the Ultimate Results in 86 Fibroid Tumors, Treated by the Apostoli Method," Dr. G. Betton Massey, Philadelphia, Pa.

"Some Experiences and Experiments in the Construction of High Tension Coils and Electrodes," Dr. Frank W. Ross, A. M., Elmira, N. Y.

"Electricity Considered in Its Relation to Surgical Gynaecology," Dr. O. S. Phelps, New York City.

"A Clinical Report of Case of Rectal Phlebitis Treated with Galvanism," Dr. D. B. D. Beaver, Reading, Pa.

"On the Electro-Therapeutics of the Constant Current," Mr. A. E. Kennelly, F. R. A. S., Philadelphia, Pa.

Title to be announced, Dr. M. A. Cleaves, New York City.

Title to be announced, Dr. Fred. H. Morse, Melrose, Mass.

Closing Arterial Wounds by Suture.

Dr. Heidenhain, in the Centralbl. fur Chir., No. 49, 1895, cites two previously recorded cases, involving in one instance the common femoral, in the other the common iliac. He also reports a case of his own, in which during the removal of some cancerous glands from under the armpit, and after necessary resection of a portion of the axillary vein, a wound. about an inch and a half in length was accidentally made in the main artery. The bleeding was arrested by digital compression and the edges of the arterial wound were brought together by a continuous suture of catgut. The bleeding was thus completely arrested. The lumen of the vessel was not apparently diminished. The sutures held firmly in spite of strong arterial pulsation. The patient made a good recovery, and when last seen, seven months after the operation, was quite free from relapse. The axillary artery could be felt pulsating along the whole extent of the armpit.— The Medical Record.

I think you might dispense with half your doctors if you would only consult Doctor Sun more, and be more under the treatment of these great hydropathic doctors, the clouds. Beecher.

Extracts and Abstracts.

How to Prevent Anæsthetic Vomiting.*

BY THOS. W. MUSGROVE, M. D., FAIRHAVEN, WASHINGTON.

Of all creatures known to science man is the most given to vomiting. Every organ of his body is connected by alarm nerves with the vomit center. A sudden injury to any important or vital organ will produce vomiting. In many persons a disagreeable thought, a disgusting sight, a fright, a chill, or anything that impresses the vomit-center that there is something obnoxious in the system, produces a contraction of the diaphragm, reversed peristaltic action of the stomach, with ejection of its contents; or, if the stomach be empty an attempt to vomit the stomach itself. This safeguard of life is so finely adjusted-set with a hair trigger, as it were-that vomiting frequently becomes one of the most annoying and even dangerous complications of disease in many patients. Vomiting may be a simple regurgitation, or it may be of so severe a character as to resemble the throes of parturition.

The vomiting of pregnancy, the nausea of intestinal disorders of children, the uncontrollable vomiting of meningitis, of intestinal obstruction, are all sufficiently distressing to the patient and troublesome to the physician, to try the courage and skill of the best of us. none are more annoying and obstinate than the vomiting produced by anæsthesia.

But

Nearly all patients who are deeply narcotized by any of the popular anæsthetics suffer more or less from nausea and vomiting. I believe fully ninety per cent of all persons who are kept under an anæsthetic more than half an hour are made sick. If ether is used, about 60 per cent vomit. If chloroform, about 40 per cent. If nitrous oxide, not more than 10 per cent, but it is very seldom that anyone is kept under gas half an hour.

In abdominal surgery, the vomiting during and after the operation is often exceedingly troublesome, and sometimes dangerous.

These statements are so well known to the profession that I need not elaborate or quote authorities to prove them. We all know them unpleasantly well. The question is how to prevent anæsthetic vomiting. As both the etiology and process of vomiting is very complex it is plain that there is no simple method of preventing it. The only rational method is to keep in mind and etiology and physiological process of vomiting, and put the patient in a *Read before the Washington State Medical Society, May 19, 1896.

Every patient who has to undergo a severe operation, especially an operation of election, should be especially prepared, both mentally and physically, to withstand shock and pain.

Many surgeons have given years of patient and intelligent investigation to the best methods of preparing patients for operations under anææsthetics, yet we have not a system that is fully satisfactory and generally adopted by all surgeons. All agree on a few things. No surgeon will give an anæsthetic to a patient except in a grave emergency, soon after eating solid food. Six to eight hours is considered sufficient time after a meal. Twelve or more hours is apt to leave the patient hungry and less able to stand an operation. My own method is to empty the alimentary canal thoroughly the day before the operation, and give liquid food only the night before and malted milk or soup four hours before the operation. An especial effort should be made to have the stomach and bowels free from gas.

Few patients should have morphia in any form before giving an anæsthetic. Morphia often aggravates the nausea. Whiskey does the same thing and should not be given before the operation. In fact, all depressing anti-pyretic drugs should be avoided. Keep the patient's mind as cheerful as possible, and the strength as great as possible. Keep the patient warm. The rapid evaporation of all anæsthetic cools both the patient and the surrounding atmosphere, and many a lung complication has been produced by the great reduction of temperature rather than by any other factor in the operation.

A very warm room-about 80 degrees F.— warm, dry flannel clothing, kept in close contact with the patient's skin, and as small a field. for the operation as possible exposed to the air, will prevent shock and chill and thereby counteract the tendency to vomit after the operation.

2nd. Selection of anaesthetic.

After using pure ether-as I was taught at Harvard by the renowned Bigelow-for ten years, and then having associated with surgeons who were educated in Edinburgh, under the influence of the celebrated Sir James Y. Simpson, I used chloroform mostly for five years, but the surgeons from whom I learned the use of chloroform having a very sad death from it in the hospital, the board of directors

passed a resolution prohibiting the use of chloroform in that institution, except in especial cases. I began the use of the A. C. E. mixture about ten years ago, and have used it almost entirely ever since with the utmost satisfaction.

The A. C. E. mixture is composed of one part of pure 95 per cent alcohol, two parts of pure chloroform, and three parts of pure ether, by volume. This mixture keeps well in the dark. It should be given on a hollow sponge, covered with a leather case, with an opening in the top that can be opened or closed, as the surgeon giving the anesthetic deems neces

sary.

3rd. Method of giving an anæsthetic.

Begin with a half a drachm of the A. C. E. mixture on the sponge and let the patient inhale it slowly. The more through the mouth at first the better. Take at least ten minutes to bring the patient fully under its influence. During the operation give just enough of the anæsthetic to keep the patient quiet. Many patients are so saturated with the vapor that it is no wonder they vomit and have no rest for many hours after the operation.

4th. After-treatment.

If the method just outlined be skillfully carried out, there will be but few cases requiring special after-treatment.

Vomiting will be reduced to a minimum. But in the cases where shock and the anæsthetic have produced nausea and vomiting, there is nothing better than one drop doses of wine of ipecac on the tongue every half hour for two or three hours. If there be much pain a hypodermic of morphia will often relieve the patient, but in abdominal operations the less morphia used the better as a rule.

Ice has not been of much use in my experience. It does for a little while, but in one or two hours the tongue glazes and the stomach becomes uncomfortable. A mustard plaster on the back of the neck often relieves the patient. The skin should not be blistered. Over medication is sometimes the cause of vomiting. The hypodermic injection of digitalis, ether, strychnia and whiskey is often so heroically employed that the brain centers are driven to the utmost exertion of their power to expel so much poison from the system by vomiting.

The tendency of the surgeon is to conclude that so long as his treatment does not kill the patient, that nothing he does causes any harm. Unfortunately, the human mind is so constituted that any man is liable to fall into error regarding his most cherished work, consequently we fall into habits of dosing that are often unnecessary and sometimes injurious. The simplest medication is surely the inost scientific, and the complex is so difficult to fully understand that no one can be absolutely sure

that he knows the post hoc from the propter hoc.

For the sake of brevity, I have not made quotations or referred to authorities, but simply put the conclusions of my studies and practice of twenty-five years in as small a space as possible. I have never had a death in my practice, nor under my care from an anæsthetic. I have given anæsthetics in many cases, for all kinds of operations, and never had but one fright in all of them. A young woman came to me to have some teeth extracted. She disliked ether so much that I gave her chloroform, and if I had not been on the alert, she would have died in the chair. By quick work

The new building was erected by the funds of the A., T. & St. F. Hospital Association, completed and turned over to the board of trustees on May 21 of the current year, and by them immediately turned over to the chief surgeon, Dr. Geo. W. Hogeboom, for equipment and opening. It was partially equipped and opened on the 22d of June, in immediate charge of the superintendent of hospitals for the association, Dr. J. R. Fay.

Its construction is sandstone from Flagstaff, Ariz., for the first story, and for the stories above pressed brick. Its capacity is from 75 to 100 patients. There are three general wards with a capacity of 18 beds each, three

I lowered her head and pulled out her tongue, and she began to breathe again and soon recovered. So I would say never give chloroform to a patient in a dentist's chair, with his clothes on, and no preparation. Medical Sentinel.

The New Santa Fe Hospital at Topeka.

The engraving presented herewith shows the exterior of the new hospital erected at Topeka, Kan., by the hospital department of the Atchison, Topeka & Santa Fe Railroad. This is the fifth hospital of the system. The other four are located at Ft. Madison, Ia., Ottawa, Kan.. La Junta, Colo., and Las Vegas, New Mexico.

small wards of 4 to 6 beds, and the balance single rooms. This capacity can be safely increased one-third if necessary to do so. Its interior construction is of the most modern type. Its heating and ventilating is of the Sturtevant system, by fans propelled by electricity, by which the air in the entire building can be changed in 10 or 12 minutes, without the stirring of a feather held in midair in any room; and in each ward or room occupied by patients the heat is controlled by the Johnson automatic heat control, by which the temperature can be maintained at any desired degree. Since its opening it has administered to a daily average of from 20 to 25 patients, which is constantly increasing. Its patronage from out

side patients has been at the rate of $150 per month, which is also increasing. It is in universal favor with the profession, especially for its capacious and well-equipped operating

room.

In reference to the utility of the Railway Employes' Association, the chief surgeon says that this association was organized in 1884 and since that time to date the evidence has been complete and conclusive of the good effects and results of such association, both to the employe and the railway company; and he earnestly urges all railway companies to favor such organizations.

Fracture of the Os Calcis, with Report of a Case of Comminuted Fracture with an Unique Method of Treatment.*

Dr. Henry M. Joy of Grand Rapids, Mich., reports the following interesting and instructive case in a recent issue of the Annals of Surgery:

Fracture of the os calcis of any variety, notwithstanding the peculiar liability of this bone to injury from its location, may, I think, be classed among the rare fractures with which the general surgeon has to deal, and there. exists, I think, a corresponding scarcity of literature upon the subject.

The os calcis may be fractured either by muscular action, in which case the lesion is immediately below the insertion of the tendo Achillis and is accompanied with marked upward displacement of the fragment due to mucular contraction, or the injury may be caused by direct violence, as from a fall upon the foot. Fractures due to a fall are usually comminuted, and may be diagnosed by the flattening and broadening of the sole and heel, which is observed when comparison is made between the injured and the sound foot.

Crepitus may or may not be present, but if present is most readily obtained by rotating the foot and at the same time holding the heel, or by holding the heel and flexing the ankle. The treatment of these injuries will be referred to in connection with the following

case:

Mr. B., aged twenty-one years, while suffering from an attack of delirium tremens, jumped from a second story window in his stocking feet to the frozen ground, a distance of about twenty feet,-he landed squarely on his feet, then fell forward onto his face.

Notwithstanding the injury sustained he succeeded in rising and ran some thirty or forty yards before being captured and returned to the hospital.

Examination showed the presence of a transverse fracture immediately below the in

*Read before the Grand Rapids Academy of Medicine. ✦ American Text-Book of Surgery.

sertion of the tendo Achillis, due probably to muscular action in the attempt to prevent falling forward after striking the ground.

Evidence of flattening and broadening of the sole of the injured heel, when compared with the sound side, led me to suspect a fracture of the subastragaloid portion of the bone, though no crepitus could be obtained.

The action of the tendon was so marked that the upper fragment was separated about two inches from the lower portion of the bone, with the skin tightly stretched over it, and attempts at reduction either by manipulation or position with flexion of the leg and overextension of the foot being unsuccessful, an operation was deemed advisable. An incision was made in the median line of the plantar surface of the heel extending over the heel and about three inches along the course of the tendo Achillis, which was exposed by the incision. After the incision was completed, a large quantity of effused blood escaped from the wound, when it was seen that the subastragaloid portion of the bone was crushed into three fragments of different sizes.

The extensive comminution rendered the use of either nails or the ordinary method of wiring impossible, and a somewhat unique. method of treatment was adopted. The tendon was first severed by an oblique incision, beginning at the outer side one inch above its insertion into the bone and ending on the inner side about two inches above the starting point. It was then easy to slip the upper fragment with its attached portion of tendon down into place.

A medium-sized silver wire was then passed through the tendo Achillis at its insertion, then through the tissues immediately surrounding the various fragments, returning to the point of insertion, thus fixing the fragments at the periphery of each, so that when the suture was completed the fragments were inclosed in a loop which, when drawn taut, brought the parts into perfect apposition. A few turns were then taken in the wire and the ends cut off. The severed tendon was next united with fine silk, the wound closed with silkworm-gut and dressed, and a plaster-ofParis cast applied with the foot in an over-extended position to secure as much relaxation of the tendon as possible, and thus avoid any tendency to separation of the fragments or of the ends of the divided tendon from tension.

The wound was first dressed and stitches removed on the eleventh day, when primary union of the cut surface was found complete. second cast was applied at this time with the foot still over-extended.

Fearing lest too firm adhesion might form between the tendon and the surrounding tissues the cast was removed at the end of two weeks, making in all about four weeks that the