Extracts and Abstracts. day a slight discharge appeared which was Compound Fracture of Thyroid Cartilage. Dr. E. L. Bell, North Woodstock, N. H., reports the following case in a recent issue of the Medical Record: Although accidents somewhat similar to the one here recorded may not be uncommon, this case seemed to me interesting, not only on account of the complicated nature of the injury, but also on account of the uninterrupted recovery under manifestly unfavorable circumstances. J. K., aged twenty-nine years, cattleman, while loading a vessel was gored in the throat by a steer. He was brought to the Boston Emergency hospital in an ambulance. Examination disclosed an exceedingly large, dirty, lacerated wound, extending irom the median line of the neck to the edge of the sheath of the large vessels of the neck on the right side. All the larger muscles covering the larynx and trachea were reduced to pulp, with the exception of a few remaining shreds. The two alæ of the thyroid cartilage were completely separated in the middle line. The right ala had a longitudinal fracture involving two-thirds of its surface. The crico-thyroid membrane was ruptured and the cricoid cartilage was badly bruised. The trachea was opened throughout its whole extent almost down to the sternum. The thyroid body was apparently entirely destroyed. Hemorrhage had at first been severe, but it was easily controlled by a temporary dressing. There was a large lacerated wound under the right ear, which was immediately closed with silkworm gut. The patient was placed in the tracheotomy position. The anesthetic used was cocaine in four per cent solution. Under strict asepsis, with the assistance of Dr. W. B. Segur, I cleansed the entire region with a weak bichloride solution, removed the loose fragments of cartilage, trimmed the edges, fitted and fixed them in place with fine sterilized silk. The different shreds of muscles were next cleaned, patched and fastened in proper places, as were also the tracheal rings. The fascia and skin were next sutured with silkworm gut and covered with simple antiseptic dressing. Beyond passing reflex spasms of the glottis and some slight dyspnoea, the patient seemed to suffer no great inconvenience; but he was watched carefully for any signs of approaching cedema or septic pneumonia. The temperature the day after the accident was 100° F. and remained at this point or below during the man's stay in the ward. The wound was dressed on the third day. It then exuded a little dark blood on pressure. On the fifth found to come from a small sinus resulting from deep muscle-suture irritation. On the eighth day the external sutures were removed. Under daily dressings the discharge had seemed to lessen. On the twelfth day two silk muscle sutures sloughed out and were removed. On the sixteenth day the sinus was curetted under cocaine anesthesia. The next day there was but little discharge and in a week the wound had entirely cicatrized. Step by step, beginning the day after the injury was received, the gradual change from almost complete aphonia to approximately perfect vocal action could be plainly marked. In fact, I am inclined to believe that if the patient's supply of stimulants during his convalescence could have been curtailed, the slight amount of huskiness present on his discharge would have been much less noticeable. The plan of using a trachea tube and allowing the surface to close in with more or less rapidity has been suggested, but it has seemed to me that the method followed in the instance above outlined, provided the case can be watched, is much quicker and easier both for patient and surgeon. Spinal Surgery. Chipault (Rev. de Chir, February, 1896) reports three cases of successful operation on the spine. The first was one of partial compression of the cord by a fragment of bone detached from the left half of the eleventh dorsal vertebra. The chief symptoms were motor paralysis of the left lower extremity, anæsthesia of the right extremity, and loss of power of the sphincters of the bladder and rectum. On the eleventh day from the date of injury, after exposure by a long vertical incision of the lower portion of the dorsal spine, a projecting piece of bone was found, which consisted of the left lamina and a part of the left side of the body of the eleventh dorsal vertebra, which had encroached on the left half of the canal and com pressed the corresponding portion of the cord and the nerve roots. This portion of bone was removed in fragments, the rent in the dura mater sutured, and the wound closed without drainage. drainage. The symptoms gradually disappeared after the operation, the patient was able to walk without any support at the end of the fifth month, and when last seen after an interval of two years and a half was quite free from any result of his injury save some weakness of the bladder and anus. The second case was one of extension of the fourth and fifth cervical nerve roots by a subluxation forward and to the right side of the fourth and the fifth cervical vertebra caused by a fall. The primary symptoms of weakness of all the limbs gradually subsided, but resulted in persistent motor and sensory disturbances in the left upper limb, the muscles of the shoulder and arm being paralyzed, and the skin over the shoulder and along the outer surface of the arm and forearm very hyperæsthetic. Thirteen months after the accident the seat of injury was exposed, and the nature of the injury, which had previously been diagnosed, clearly made out. The displaced fourth cervical vertebra, which was movable and could be readily reduced, was fixed in its normal position by silver wire attaching its spine to the spines of the third and fifth vertebra. This patient also made a good recovery. At the end of the second year he was able to move his head freely from side to side, and the left upper limb had regained its normal strength, and was quite free from tenderness. The third operation was performed for the cure of very painful and persistent neuralgia of certain closely circumscribed regions of the right upper extremity. After the trial of many plans of treatment, both medical and operative, the patient was completely relieved after exposure of the cord in the cervico-dorsal region, and resection of the posterior nerve roots corresponding to the last two cervical and the first dorsal vertebra.British Medical Journal. The Duty Line in Medical' Journalism. The following excellent paper was read by Joseph R. Clausen, A. M., M. D., managing editor of the Times and Register, before the American Medical Publishers' Association, Atlanta, Ga., May 4, 1896: The most carefully edited journals are not, as a rule, either the most popular or the most successful. This is a discouraging statement to make, and the sadder for being true, for true it is. Were the reverse the rule, two powerful incentives would exist for the more careful editing of our columns-popularity and profit; but, since this is not the case, it is duty, not business enterprise, that calls for a closer editing of copy and galley proof; nor from title page the "ad" that disfigures the cover should anything escape this editorial scrutiny and revi sion. to It is hard, at times, to do one's duty, even when the plaudits of the populace, to say naught of their shekels, will in the end reward our efforts, but for an editor to conscientiously do his duty, recognizing at the time that in the doing of it he is lessening the popularity of his paper and the size of his income, is harder still. Yet it is the unflinching performance of this duty that we urge, insisting on it not alone for duty's sake, but because concerted action in this direction would soon restore medical journalism to the high eminence from which we feel it has fallen, and the faithful performance of the duty referred to would soon receive other and more substantial reward than virtue's own. In short, the entire situation would be changed and the best edited papers would at once be the most successful and popular. It is high time that the duty line in medical journalism was drawn and universally recognized when, as a unit, the medical press shall say to the abuses that threaten its usefulness: "Thus far shalt thou go, and no farther." A line, too, that shall shut out the petty weaknesses that now impair its dignity and lessen its influence. And what are these abuses, these weaknesses? First, sensationalism-that bane of the newspaper press of to-day. Disguised, of course, in physician's garb, but none the less insidious in character, and all the more harmful in its influence. Too great readiness to give space to the discussion of questionable theories, to the exclusion of sound, instructive argument in support of those that have been proven tenable. A tendency to overshoot the intelligence of our readers, forgetting that we are writing to the many not the few, and that every general practitioner is not a specialist. A disposition to, at least, passively, encourage professional "fads" simply because they are popular, instead of vigorously opposing them and mercilessly exposing them as fads. A forgetfulness of the fact that we are, or are supposed to be, leaders of medical thought and not caterers to the perverted tastes of professional or literary epicures. The ridiculous practice of expressing plain truths in such stilted, awe-inspiring language that the truths themselves are wholly obscured in the verbiage of words that clothe them. A disposition to make our editorial columns subservient to the advertising pages, forgetting that even the negative endorsement of a medical journal has an influence that can scarcely be calculated and may be given a publicity by the advertiser that we ourselves would be most reluctant to have it given. And last, but by no means least, the too frequent surrender to that potent factor-a yearly contract and the acceptance of advertising that should have no place in the columns of a well-edited medical journal that respects the principles it professes to uphold. We mean, in short, that the advertising columns should be as carefully edited as any in the paper, and that no preparation or article should be advertised that we cannot fully, intelligently and conscientiously endorse. It is no new code of newspaper morals that we ask shall be adopted, but recognizing our high mission as the medical press of this country, that we return to first principles, those that combine honesty with common sense.— Times and Register. Miscellany. Relations of Medical Examining Boards to the State, to the Schools and to Each Other. Dr. William Warren Potter of Buffalo, president of the National Confederation of State Medical Examining and Licensing Boards, chose this title as the subject of his annual address at the sixth conference of this body, held at Atlanta, May 4, 1896. He said there were three conditions in medical educational reform on which all progressive physicians could agree, namely, first, there must be a better standard of preliminaries for entrance to the study of medicine; second, that four years is little time enough for medical collegiate training, and third, that separate examination by a state board of examiners, none of whom is a teacher in a medical college, is a prerequisite for license to practice medicine. It is understood that such examination can be accorded only to a candidate presenting a diploma from a legally registered school. He further stated that a high school course ought to represent a minimum of academic acquirements, and that an entrance examination should be provided by the state for those not presenting a high school diploma or its equivalent. He did not favor a national examining board, as has been proposed, but instead thought all the states should be encouraged to establish a common minimum level of requirements, below which a physician should not be permitted to practice; then a state license would possess equal value in all the states. In regard to reciprocity of licensure, Dr. Potter thought it pertinent for those states having equal standards in all respects to agree to this exchange of interstate courtesy by official indorsement of licenses, but that other questions were of greater moment just now than reciprocity. Until all standards were equalized and the lowest carried up to the level of the highest, reciprocity would be manifestly unfair. He urged that the states employ in their medical public offices none but licensed physicians. This, he affirmed, would tend to stimulate a pride in the state license, and strengthen the hands of the boards. He denied that there was antagonism between the schools and the boards, as had been asserted. He said that both were working on parallel lines to accomplish the same purpose, that there could not possibly be any conflict between them and that they were not enemies, but friends. The medical journals of standing, from one end of the country to the other, he affirmed, were rendering great aid to the cause of reform in medical education, and the times were propitious. He concluded by urging united effort by the friends of medical education, saying that "the reproach cast upon us through a refusal to recognize our diplomas in Europe cannot be overcome until we rise in our might and wage a relentless war against ignorance, that shall not cease until an American state license is recognized as a passport to good professional standing in every civilized country in the world." Vivisection. From the minutes of the American Academy of Medicine for May 4, 1896. (Advance sheet from the Bulletin of the Academy.) The following resolutions, presented by Dr. Gould, and recommended by the council, were discussed and adopted unanimously: Resolved, That the American Academy of Medicine desires to express its opinion that no legislation is required or desirable in the United States in regard to the so-called practice or subject of "Vivisection," and for the following reasons: 1. Because only by careful discrimination and collection of facts can public and legislative opinion be truthfully formed. To illustrate but a single of many popular errors upon this subject: the dissection or use of dead animals by scientific men is termed "vivisection," when the same proceeding carried out by the butcher, the hunter, the restaurant keeper, cooks, etc., does not enter into the consideration, neither do the cruelties in the use and keeping of domestic animals, nor those in the deaths of animals for other purposes than those of experimental medicine. 2. While admitting and deploring the facts of abuses in the past and in some European countries to a very limited extent also in America--it is the conscientious belief of the members of the academy that at present with us such abuses do not exist, nor are they in danger of occurring, to a degree justifying or calling for legislation, as, under the circumstances, the evils that would inevitably result from such legislation would greatly exceed the benefits to be obtained by it. The charge implied or openly made that physicians, either in theory or in practice, are more cruel than other classes of the community, is a fancy or prejudice of ignorance which cannot be proved, and which we strenuously deny. 3. Legislation upon the subject of cruelty to animals should be so framed as to include consideration of cruelties infinitely greater and more extensive in many other fields of human activity at present not actively objected to by those who urge legislation as regards ex perimental medicine. Not only this, but legislation concerning these matters should be broadened out in order to prevent the destruction of species of birds and other animals by the votaries of fashion, by the hunters, etc., to prevent derangement of the delicate balance of animal and vegetable life upon which civilization ultimately and largely rests, to prevent deforestation of the headwaters of our streams, to establish sanctuaries or resorts for animals, and many such biologic requisites, as also to establish such arrangements with other nations as will insure their permanent and extensive effectualization. 4. Legislation upon a subject of vital importance to a peculiarly technical branch of science should be framed under the guidance and by the aid of those who by education and experience are alone fitted and capable of forming and expressing sound judgment upon it, i. e., the experts in the special subject. It would be as absurd to have legislation as to vaccination, inspired and shaped by laymen who were anti-vaccinationists, without weighing the opinion of the medical profession, as to allow legislation upon the question of vivisection by laymen who are anti-vivisectionists, and even inexpert in any branch of inductive science. 5. The American Academy of Medicine therefore urges its members and physicians generally to write to their representatives in Congress (or wherever legislation of the kind in question is proposed), and otherwise seek to influence public and official opinion against the passage of a particularly ill-advised bill before congress, to-wit, senate bill No. 1552, introduced by Mr. McMillan, entitled "A Bill for the Further Prevention of Cruelty to Animals in the District of Columbia." In the opinon of the academy the passage of this bill would be harmful to the true interests of medical and social science and to the public health. An Appeal. O wondrous Doctor Roentgen, sir, I beg you'll quickly say Just what you deem the limits of your marvel ous new ray. For I'm a struggling writer, and I may have use for it, If some day it will penetrate another mortal's wit. I've worked and worked for many years, with not a jot of fame; My stories are but echoes, so they tell me, echoes tame. I'm but an imitator of a truly abject kind, And all because, Herr Doctor, I've no ideas in my mind. And when I see my brothers in the contest for the bay Pass by me as the tortoise left Br'er Rabbit on the way, It makes me most unhappy to reflect that 'tis my fate To copy, copy all my days, and ne'er originate. But you may prove a blessing if you'll get that ray of light Developed up to such a point that it will bring to sight The germs of thought that lie close hid in favored craniums, Like those of Mr. Kipling and the Poet of old Thrums. If I could turn that light on them and see what they've in mind To put forth in the coming years, what nuggets should I find! And should I ply with industry this dullard pen of mine, With their ideas I'd get a hold on Fame with every line. So, Doctor, pray do not abate your efforts with your light Until you've got it to the point of which I've tried to write. I do not wish to plagiarize-from that I would desist But I would be, to coin a term, a Roentgenraygiarist. -John Kendrick Bangs, in the Lotus. 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 physician 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 Address practice and goodwill at a very low figure for cash. "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 WM. 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 $85,000 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 President.... First Vice-President.. F. J. LUTZ, St. Louis, Mo. W. R. HAMILTON, Pittsburgh, Pa. 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. BY W. S. CALDWELL, M. D., FREEPORT, ILL. That greatest of American teachers, Prof. Gaylord Thomas, was in the habit of exhibiting before his class a confused looking female, whose case illustrated the subject of his day's lecture, and though none of us ever examined this woman, her presence before us helped, in a marked degree, to impress upon our minds the subject matter that fell from the lips of this great master. So I hope to-day that the interest in the paper that I am about to read to you will be fortified in a way and its monotony and want of merit obscured, in part at least, by the increased interest that you will take in the subject, from the fact that you have before you, in my own person, a patient who was for years the victim of the disease upon which I propose to discourse. The history of my case dates from a period that is coeval with my earliest recollection; and as the operation for its relief was performed when I was in my 64th year, I believe that I am warranted in the assertion that I carried this calculus longer than any other authentic case on record, where the diagnosis was confirmed by the removal of the stone from the kidney. Up to my 18th year the paroxysms of pain came on at irregular intervals, varying from a week to two or three months. Between these attacks I was well and strong and prided myself upon the fact that I could ride the wildest horse and could outrun anyone of my age. The pains came on suddenly and were most excruciating in character. To relieve these paroxysms, my father, who belonged to the most orthodox of the old school in medicine, although he had no definite idea of the true nature of my trouble, gave me *Read at the ninth annual convention of the National Association of Railway Surgeons, at St. Louis, May 1, 1896. |