been shot and the artilleryman's horse had run across some obstruction, and, as he expressed it, had broke his back. He got up and walked to the rear. The other man got up and walked a hundred yards and lay down and was picked up and the hospital force carried him to the rear. The artilleryman, I suppose, walked about a mile. Both of these men exhibited all the symptoms of spinal injury and both of them eventually died from them.

Dr. Cool: Speaking of reflexes, I said, in the absence of reflexes we wouldn't operate. Here is another thing in regard to this dislocation of the atlas. Dr. Marks reported a case of injury to the neck which drove the head down so that his neck was short. I don't think dislocation of the atlas would do that. The reason he couldn't turn his head around was that he had a fracture. That man escaped injury to the cord. You may have dislocations and fractures and no injury to the cord.

CONSULTATIONS.

BY DR. GEO. JOHNSON, SAVANNA, ILL.

When prominence in the profession of medicine or surgery is reached, either by dint of hard study, close application, and the most complete and thorough clinical advantages, or by the smiles of paternal or matrimonial fortune, the happy, and we will hope the meritorious possessor of such distinction, indeed occupies a most enviable position among those of the profession who cannot claim ability above mediocrity. It is to such distinguished physicians and surgeons that the rank and file. of ordinary practitioners turn for counsel, either sought for by themselves or demanded by their patients, into whose ready listening ears some friend (?) has poured the praises of this or that particular man, and it is from him that the one seeking counsel has a right to expect courteous and considerate treatment. The writer belongs to that class compelled occasionally to either send for, or send patients to some specialist, or some one eminent in a general way. He can recall many very pleasant associations with consulting physicians, where the good of the patient was paramount to all other considerations, while the rights of the attending physician were fully and kindly respected, and the consultation resulted, as had

been hoped, for the benefit of all concerned. He can also recall cases where, unless the attending physician was present during the examination of the patient, the case was lost to him forever. Every physician knows that if an unprincipled man is admitted to the bedside of any patient he can convince him or her that the case is not being treated properly, and further, that he is positively certain of his own ability to save the case, and he gets the patient and the fee, while the attending physician gets the blame for not being wiser. I will give a sample case occurring in my own practice, the patient being a member of one of my "best families."

Mrs. F., the mother of three children, and in good health, with good family history, except that one distant relative died of tuberculosis, consulted me in reference to an enlargement of the sternal end of the right clavicle. No particular discomfort had arisen from it, but it was very annoying to her from a cosmetic point of view, and she was very desirous that something be done to relieve her.

Examination showed a prominence of the sternal end of the bone double what would be normal. There was slight if any, tenderness, with a peculiar mobility of the joint, of such degree that I diagnosed the case as one of partial luxation of the clavicle forward, and never having seen anything of the kind, I readily assented to the proposition on the part of my patient, "as she was going into Chicago on other business," she would "call and get the advice of Prof. Blank, as he would more fully understand her case."

She visited the city, was gone some weeks, and during her absence I received a letter from the professor, of which the folowing is a copy:

larged and changed in form, giving at first glance an impression of dislocation.

As the occurrence of such an injury would be sudden, and could not be easily overlooked by the patient, and as she was totally devoid of any memory of the accident, I examined more carefully than usual.

I find the posterior border of the head of the clavicle back in its proper place, while the anterior border is only slightly advanced. The place of the joint proper is not vacant, but fully occupied by the bone. The anterior border is a little sharper and more knobby than natural and tender upon pressure. The end of the clavicle in not removed from the joint. It is movable and not anchylosed. The adjacent portion of the sternum, i. e., the right half of the upper end, is thickened and prominent. The rib just below the head of the clavicle is also prominent, and all three organs coöperate to form a sort of hill, or projection (of small size).

As the patient is of a tuberculous family, according to her account, there is reason to think that this articular and peri-articular thickening may be of tubercular origin, just like a tuberculous hip, knee, or other bony organ. This, however, cannot be decisively stated at present, but we should bear it in mind..

Tubercular joints in the early stages often recover under mere immobilization, just like a simple inflammation.

I advise that she desist from all lifting or other work with the right hand, and in every way keep it as immobile as possible.

Locally, I advise a lotion of strong alum water, containing 3 per cent of carbolic acid, or else zinc salts instead of the alum, but keeping carbolic acid.

She has lost strength very much during the last year. I suggest that she take, at present, quinine, iron and strychnia in full doses, etc.

I defer advising other medication until Dr. J. makes his report. Yours most truly,

"Blank," M. D.

Soon after receving the "opinion" Mrs. F. returned to her home, and I was summoned at once, and on entering I saw at a glance that something was amiss. She demanded why I had not "told her that she had tuberculosis," and not "subjected her to the humiliation of being told so in the city by a lot of strange doctors, after being repeatedly stripped for the

purpose of examination, and reëxamination." In as dignified a manner as possible I told her the reason was because I did not know she had the disease, and further I did not believe yet that she had it.

But she was positive as "Prof. Blank" had decisively told her so and advised her to change climate, as a possible chance for her recovery.

I then advised her to consult an eminent surgeon of my own choice, but she refused absolutely.

I never was permitted to treat the case further, and she drifted into various hands. Homeopathic and Christian Science experts had a chance at her case and her purse (a plethoric one), and she is yet, to all appearances, in good health, and "the little hill," "or projection," never seems to have made any serious impression on her outward appearance, although I am wholly unable to say just what a closer inspection might reveal.

I never received the report of the expert which was promised me after the "bacilli" were found in the sputum, in proof of the correctness of the diagnosis of a "suspicion" of "tuberculosis of the right lung," as sent to me, or the positivė diagnosis given directly to the patient.

Mrs. F. has no farther use for me, and I do not think she will again travel long distances to consult "Prof. Blank," and I certainly shall not recommend the Professor to anyone seeking skilled (?) counsel and treatment.

How happy the contrast between this wise Professor's treatment and that accorded me by one of this city's most prominent and talented professional men. In response to my message sent from the western border of the state about 3. p m., he was at the bedside of my patient at 10 p. m., and to his prompt aid and friendly counsel, I firmly believe, the restored life and health of a young wife and mother is due, and to him I certainly should again turn for advice, when in similar need. His tender attention accorded the suffering one, and kindly sympathy for the sorrowing ones, together with continued interest in the case, won for himself the lasting regard and esteem of the family. A splendid photogravure of him is the frontispiece in the September number of the "Chicago Clinical Review."

I claim that the attending physican has some rights which the consultant is by professional

courtesy bound to respect; one is that of having his own opinion given a certain amount of respectful consideration. He should not simply be made the recipient of a dissertation, containing, among other wise statements, such platitudes as: "It is movable and not anchylosed;" desist from all lifting or other work with her right hand, and in every way keep it as immobile as possible." Would not even the country physician know a better way to immobilize a clavicle than "to desist from lifting?"

A patronizing, condescending, egotistical manner on the part of the consultant, without a corresponding indication of ability, is not usually relished by other physicians any better than by the writer.

As this is a railway surgeons' meeting I know I am "off the track" and will close.

Birth and Death of Pain.

At a recent anææsthesia jubilee the following original poem, entitled "The Birth and Death of Pain," was read by S. Weir Mitchell, M. D., of Philadelphia:

Forgive a moment, if a friend's regret
Delay the task your honoring kindness set.
I miss one face to all men ever dear;

I miss one voice that all men loved to hear.
How glad were I to sit with you apart,
Could the dead master use his higher art
To lift on wings of ever lightsome mirth
The burdened muse above the dust of earth,
To stamp with jests the heavy ore of thought,
To give a day, with proud remembrance
fraught,

The vital pathos of that Holmes-spun art Which knew so well to reach the common heart.

Alas! for me, for you, that fatal hour!
Gone is the master! Ah! not mine the power
To gild with jests, that almost win a tear,
The thronging memories that are with us here.

The Birth of Pain! Let centuries roll away;
Come back with me to nature's primal day.
What mighty forces pledged the dust to life!
What awful will decreed its silent strife!
Till, through vast ages, rose on hill and plain
Life's saddest voice, the birthright wail of pain.
The keener sense, and ever-growing mind,
Served but to add a torment twice refined,
As life, more tender as it grew more sweet,
The cruel links of sorrow found complete,
When yearning love to conscious pity grown
Felt the mad pain-thrills, that were not its own.

Railway Surgeon

PUBLISHED EVERY OTHER TUESDAY BY

say about consultations with specialists, inasmuch as Dr. Johnson takes up that phase of the subject in his paper. It seems to us that the advice of the family physician or the physician in charge of the case should always be

We publish in other columns of this issue a short paper by Dr. George Johnson of Savanna, Ill., which he read at the recent meeting of the C., M. & St. P. Railway Surgeons' Association, and in which he speaks very feelingly on the subject of consultants and consultations. We do not know why the paper was not discussed at the meeting, probably from lack of time, but there is certainly much to be said upon the subject. We cannot undertake to consider all the aspects of the question, but there are some things which we would like to

sulted when assistance is needed; and, if possible, the regular medical adviser should be present at the first examination made by the specialist for the reason that he can best supply valuable data in regard to the personal history and constitution of the patient which cannot be supplied by the patient himself or his friends. If the family doctor cannot accompany the patient, perhaps to visit a specialist in a distant city, he should always furnish the consultant with a thoughtful letter containing all professional information in his possession which might throw any light upon the condition with reference to which the specialist is consulted, and especially should his letter contain those facts which the patient cannot or will not supply, and which in some instances a strange physician might hesitate to inquire about. Such a letter should, of course, be regarded as strictly confidential and its contents need not be known to the patient.

We quite agree with Dr. Johnson that the family physician should, in consultations of this sort, as well as those held at the bedside, communicate the results of the consultation, in so far as it is best for the patient and his friends to know, for in no other way can the true position of the family doctor be maintained and guarded. If, however, the patient consults a specialist in a distant city without even an introduction from his family physician, we can hardly call the interview a consultation, and if the specialist is obliged to work out the case unaided, we can hardly blame him if he frankly communicates the result of his examination, or, if he in turn calls to his aid skilled men in other departments, and the patient is told the result of their combined deliberations. As usual, there are two sides of the question.

We know it is the pleasant custom of some men in special practice to immediately acknowledge, personally, by letter or by telephone, the visits of patients referred by other physicians, even though no letter or card of introduction is presented, and this is as it should be; but we do not consider that there has been,

Interesting Cases of Injury to the Eye, With Special Reference to the Responsibility Involved.

Sterilization of Catgut.

Details of the sterilization of catgut in boiling water after hardening in a solution of formalin have already been widely published. The results have not been in every instance satisfactory, and the matter receives exhaustive treatment at the hands of Hofmeister in the last number of the Beiträge z. klin. Chirurgie (vol. xvi, p. 775).

Complaints have been made that catgut so prepared kinks up in boiling, or that it loses its strength. Omitting instances in which it has been boiled in soda solution with instruments, instead of in clear water, the failures are mostly due to the fact that the catgut has not been tightly stretched on something during the boiling, or to an imperfect washing out of the formalin. The latter process requires a long time, and the odor of formalin is plainly noticeable in catgut, which is wound in several layers on a spool, even after it has been washed several hours in running water.

Hofmeister's perfected method is as follows: (1) The catgut is wound on a glass plate with slightly projecting edges, so that the gut is free from the sides of the plate and exposed to the circulation of the fluids. The ends of the gut are fastened through holes in the plate. (2) Immersion twelve to forty-eight hours in aqueous formalin two to four per cent. (3) Immersion in flowing water at least twelve hours to free the gut from the formalin. (4) Boiling in water ten to thirty minutes. Ten minutes is amply sufficient. Boiling for an hour weakens the gut somewhat. (5) Hardening and preservation in absolute alcohol containing five per cent of glycerin and onetenth per cent of corrosive sublimate. After the catgut has been washed free from formalin it can be kept in alcohol and sterilized as required. It loses none of its strength-at least not in a month's time.

Experiments on animals have proved that formalin catgut is entirely absorbable, though not as quickly as the ordinary material.-Medical News.

The tenth annual meeting of the National Association of Railway Surgeons will meet in Chicago, May 4, 5 and 6, 1897.

BY JOSEPH A. WHITE, A. M., M. D.

In presenting for your consideration the following three cases of wounds of the eye-ball, I do so not because there is anything rare or uncommon in the nature of the injuries or the progress of the cases, but merely to awaken your interest in this class of accidents and to elicit some discussion of the question of the responsibility involved on the part of the employers All of us are aware that railway and other corporations are frequently mulcted in damages where they are not at all responsible, juries frequently having their sympathies aroused in favor of the injured person, and giving pecuniary compensation simply because it is an individual against a corporation. Whilst it is our duty to protect these corporations against such imposition, I think it is equally our duty to see that justice is done an injured person where there is any negligence on the part of the employers, even when we represent the latter in our professional capacity. I submit the cases as follows:

Case 1. D. S. R. J., aged 42, engineer on the Norfolk and Western R. R., was injured December 3, 1895., in the right eye by the bursting of the feed glass of the lubricator, a piece of the glass striking him in the right eye and cutting it open. The wound was at the inner junction of the cornea and sclerotic, and penetrated through the iris and ciliary bodies. The iris was protruding through the wound. I cut this off and applied an antiseptic dressing. I told him that in all probability he would lose the eye, as I was satisfied there was a piece of the glass from the broken lubricator inside. He protested vigorously that there could not be any of the glass in the eye, as he had seen the piece which caused the wound. I told him that, independent of the presence of the foreign body, the proximity of the wound to the ciliary region, rendered it exceedingly dangerous, not only to the eye that was wounded, but to the other eye. He said he would prefer my attempting to save the eye, as the left eye was damaged some years ago by an accident and was not perfect Through the month of December he came to see me every other day, and after the first week or ten days the eye began to improve. Just after Christmas, however, the tension of the eye became bad, and it showed evident signs of shrinkage. I urged him to have it removed as it was perfectly useless to attempt to save it, and it was endangering the sight of the only