temic effects. Under the use of antiseptic agents, applied continuously for some time, complications were not of infrequent occurrence, but after nearly six months use of simple dressings, we are free to confess that the treatment in every way excels the use of antiseptics. Again, when we have a slowly healing granulating surface, the use of the normal saline solution makes the application of skin grafts very simple, and we believe that it will be only a matter of time when almost all granulating surfaces will be treated by the application of root sheath hair grafts, for in this way we can obtain a more rapid healing of a granulating surface than can possibly be obtained in any other way. AN UNUSUAL ACCIDENT. Case VI.-M. S., a brakeman on the Col. St. L. I. M. & S. Railway, while attempting to remove a coupling pin from a moving car fell astride of the rail and in this position was pushed some eight feet by the wheel; the flange of the wheel crushed off the lower portion of the scrotum, fortunately not involving the testicles. The penis was somewhat contused and lacerated and the thigh was contused and lacerated in its middle third, but no bones were broken. The negro's prayer and argument were as unique as his injury, as he said: "Doctah, for the Lawd's sake don't cut off dat dar," pointing to the penis; "if you cut off my leg why den I can get a cork leg, but if you cut dat off, al de king's horses and all de king's men can't put it back again. Save it for my sake; save it for de Lawd's sake." It is needless to add that both were saved, but extensive sloughs occurred upon inner aspect of the thigh and upon the penis and scrotum. While both were somewhat severely injured, yet under treatment they are doing well. GENERAL CONCUSSION, Case VII.-I. Mc., a brakeman, aged 22, in the employ of the St. L. I. M. & S. Railway, was brought into the hospital five hours after an accident. He was contused upon his face, hands, legs and body. While his physical injuries were painful and rather extensive, his mental state presented anomalous features, which were the interesting part of the case. The cause of his mental excitement will be better understood when the circumstances of the injuries are related. It was a dark, rainy night and I. Mc. was the rear brakeman upon a remem freight train of some forty cars. The train broke in twain just as they were descending a short hill, and, realizing that a fast passenger train, which was following, could not be very far off, I. Mc. snatched a lantern and, without thought of consequence, jumped off of the rapidly moving train. He was dashed to the earth, thoroughly bruised and stunned, his lamp being broken to pieces, and in the dark he started and ran with all his might in the direction of the coming passenger train. It finally dawned upon him that he had nothing to signal with, but bering he had some matches and a pocket handkerchief, he after some difficulty managed to set fire to the latter, and was enabled to successfully stop the passenger train, thus preventing a serious collision. When brought to the hospital he was almost in an hysterical condition, and in spite of his painful injuries he could and would not remain in bed. He would talk, in a loud, explosive manner, and in the relation of his accident his eyes would glare and he would gesticulate vehemently, and when left alone would keep up constant conversation with imaginary persons. There were no indications of cerebral injuries. It was plainly a case of hysterical excitement incidental to the intense mental strain he had undergone. He was put upon bromide of potash, 30 grains every second hour, with 15 grains of trional administered alternately. Improvement was rapid, and at the end of ten days he was in a normal condition. SNAKE BITE- PECULIAR TREATMENT. Case VIII.-A. K., a section hand, aged 23, in the employ of the St. L. I. M. & S. Railway, while attempting to remove some railway ties from a swamp, was bitten twice upon the back of his right hand by a water moccasin (toxicophis pisicivorus). Realizing what had happened, he killed the snake, then washed his hand and sucked the part and then put a tight ligature around his wrist. He was then promptly inebriated with whisky, and with this a chicken poultice was applied to the bitten hand. The chicken poultice used was prepared in the following manner: A live chicken was caught and split open from breast to back, while living, and the bitten. hand stuck in among the warm viscera. We learned that no less than ten chickens were thus applied. As fast as one would die a new one was used. The patient placed more reliance upon the efficacy of the chicken poultices than he did upon the other remedies used. Upon examination of the hand twentyfour hours after the bite there was considerable redness and oedema, and four punctured wounds were plainly visible upon the back of the hand. The patient was under treatment some fifteen days. Only carbolized poultices were used and the hand put upon a splint. OBITUARY. J. F. Edgar, M. D. Dr. Edgar was born July 1, 1863, at Newton, Ia. After graduating in the public schools of that place at the age of eighteen, he took a two years' course in medicine at St. Joseph, Mo., and subsequently one year at Des Moines, Ia., graduating there in March, 1885. He then located in Edgar, Ia., and commenced the practice of his chosen profession. He was a stranger in a strange land, but having full confidence in his own knowledge and ability, he began the struggle for success as a physician with a courage and determination which could but inspire admiration. The doctor belonged to several secret societies, in all of which he took an active part; he also belonged to the Nebraska Eclectic Medical Society, and was a member of the National Association of Railway Surgeons, and local surgeon to the Grand Island Railroad at Edgar. He was married to Miss Frances Hart, May 16, 1886, and there were born to them Grace, now aged 7, and Vera, aged 3, all of whom survive him. The news of his death, which occurred on the morning of August 22, 1895, while out on a professional trip in the country, was very sudden and was a terrible blow to his family and friends, and the general feeling was that what would have been a bright light in the medical profession had been blotted out. Extracts and Abstracts. Alcohol as a Disinfectant for the Hands. The advantage of using alcohol in the disinfection of the hands has been prominently emphasized during the last year. Ahlfeld and Vahle publish an interesting article in the Deutsche Medicinische Wochenschrift of February 6, 1896, supporting alcohol as a disinfecting agent. Fürbringer supposes that the alcohol frees the hands of fat and allows the subsequently applied disinfectant to exercise a more powerful action upon the micro-organisms of the skin. Reinicke also ascribes to alcohol the property of taking up fatty substances from the skin; but since he demonstrated that the alcohol has in itself a subsequent disinfectant action upon the hands, he explains that the water is able to wash off the fat which, mixed with bacteria, had been dissolved by the action of the alcohol. Körnig believes that the alcohol-action is a deceptive one; that the alcohol does not kill bacteria, but that its astringent property so alters the skin that the bacteria are retained in the shrunken epidermis and cannot therefore grow upon nutrient gelatin. Opposed to these three modes of explanation, Ahlfeld and Vahle emphasize the statement that alcohol has really a bactericidal property which, however, is able to exercise its action only under certain circumstances— namely, when the micro-organisms themselves contain water. Before these two authors proceeded to make an experimental effort to establish their own theory of the action of alcohol, they commenced by experimental methods to confute the first-mentioned theories. They found that ether, which removes fat from the hands more readily than does alcohol, did not give the same sterilizing effect, so that of thirty-six pupils who had endeavored to sterilize a finger in this manner, only eight succeeded in producing a sterile digit-that is, 22.22 per cent; while of those who used alcohol, according to the usual method, instead of ether, 88.88 per cent succeeded in obtaining a clean finger. The third theory is contradicted by the fact that after the use of the alcohol the hand was placed for at least five minutes in hot sterilized water, and in spite of this soaking and softening the sterilizing action of the alcohol was not removed. Having confuted the other theories, Ahlfeld and Vahle explain the different action of the alcohol upon moist and dry micro-organisms. They dipped dry staphylococcus silk threads into alcohol, and supposed that the subsequent cultures obtained by the planting of the silk into nutrient media were due to the formation of a stiff layer upon the outer surface of the bacterial mass, so that the cocci upon the interior of this mass remained at a distance from the action of the alcohol and were therefore not destroyed. The practical outcome of the whole matter is, that alcohol must be regarded as a strongly sterilizing material in cleansing the hands when we have to deal with the ordinary bacteria of the operating room. It should be applied thoroughly with a stiff brush for several minutes after washing with soap. A bichloride or carbolic-acid solution should then be used, as usual.-Medicine. A Case of Traumatic Ophthalmoplegia. Dr. David Webster of New York reports the following rather unique case in the Medical News of February 29, 1896: On the 17th of November, 1895, Edward F. McC., aged 6, while walking with a slate-pencil in his hand, stumbled and fell on a board sidewalk. He was picked up in a semi-unconscious state and taken home. Dr. Edward L. Bull was called to see him soon after the accident, and found ptosis, with total ophthalmoplegia of the right eye. There was a puncThere was a punctured wound beneath the right orbital edge, at about the junction of its middle and inner thirds. Besides this wound of the upper part of the eyelid, which was still bleeding, there was a slight bruise or mark on the brow, as though it had struck upon the pencil lengthwise. Dr. Bull examined the parts carefully, but could find no foreign body. On testing the vision of that eye the boy counted fingers and recognized a watch, but it is now doubtful if he saw the fingers with the injured eye, and the loss of sight may have been immediate. It is certain he had no perception of light in the eye a few days later. He looked pale and felt sick, and vomited from time to time for fortyeight hours after the accident. He then recovered his usual health and went about his play as usual, and has been well, so far as his general health is concerned, ever since. Dr. Bull sent him to me a few days after the accident. I found total blindness of the right eye, with absolute ophthalmoplegia and ptosis. The third, fourth, sixth and optic nerves were totally paralyzed. Ophthalmoscopic examination showed nothing abnormal in the media. or in the fundus. It was thought there was slight exophtalmus at first, but I was not sure there was any when I saw him. He has had no pain in or about the eye at any time since the injury and there have been no indications for treatment. When I saw him on January 8, 1896, there had developed a slight paleness of the right optic disk. He had also recovered the power to raise his right upper lid a very little; otherwise, the status remained unchanged. There is now not only well-marked atrophy of the optic disk, but a neuro-paralytic keratitis has developed itself. The eyeball is slightly red and the cornea is hazy and anæsthetic. The problem in this case is as to the nature of the injury. It seems to me most probable that the slate-pencil entered the orbit, injured the lenticular ganglion and fractured the walls of the orbit at or near its apex. The pencil may still be partly in the orbit and partly in the cranial cavity. I presume the same symptoms could have been brought about by fracture of the orbital walls from the force of the blow of the brow upon the board sidewalk, and possibly even by shock or concussion; but the punctured wound seems to indicate that a portion of the slate-pencil is embedded somewhere in the orbital tissues so deeply as not to be felt with the finger. The nature of their profession exercises so great an influence on that longevity that only twenty-four out of every hundred attain their seventieth year; so that those who study the art of prolonging the lives of others, are most liable to die early, probably on account of the physical evils to which they are constantly exposed.-Davies. That city is in a bad case whose physician has the gout.-Hebrew. 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 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 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 $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 Health vs. Money.... EXTRACTS AND ABSTRACTS: Contraction of the Flexors of the Hand Cured by Shortening the Bones of the Fore arm... 98 106 110 111 112 Treatment of Ankylosis of the Hip...... 111 Death Under Chloroform...... Report of Two Fatal Cases of Hæmaturia. 113 Chloroform Narcosis and Albuminuria... 114 Case of Sternal Dislocation of Second and Third Costal Cartilages and of Clavicle, with Fracture of the Fourth and Fifth Cartilages... Removal of the Entire Clavicle for Osteomyelitis; Complete Regeneration of the Bone.. Local Peritonitis. NOTICES AND REVIEWS...... MISCELLANY: 114 115 116 .. 117 President.. Seventh Vice-President... E. W. LEE, Omaha, Neb. 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. No. 5. THE SYMPTOMS, THE DIAGNOSIS AND THE INDICATIONS FOR THE TREATMENT OF ACUTE INTRAABDOMINAL INJURIES WITHOUT EXTERNAL EVIDENCE OF VIOLENCE.* BY JOHN B. DEAVER, M. D., PHILADELPHIA. Mr. President and Gentlemen, Members of the National Association of Railway Surgeons:-The honor conferred by your distinguished president, Dr. Murphy, in selecting me to deliver the address on surgery before this association is highly appreciated. I fear, however, that I am not able to do full justice to the occasion. The railroads of the United States have assumed such magnificent proportions that to-day they far surpass those of any other land, both as to business and equipment. They represent more capital and employ more men than any other class of industries in this very progressive land of ours, and we, as Americans, must feel a just pride in the accomplishment of such success. Your organization, therefore, represents the medical side of America's greatest industry, and you may be proud of the influence and opportunities for good which are afforded you. The success of your organization, like that of the railroads with which you are associated, is largely due to the completeness and the practical workings of your system. Our profession is peculiar in its relation to mankind. In olden times the doctor was the priest, and to-day we have not finished our duty to a patient when we have administered the proper remedies for the ailment for which we have been consulted. We must constantly strive to discover other methods to overcome the effects of disease. We give our time, our *Read at the ninth annual meeting of the National Association of Railway Surgeons, at St. Louis, Mo., May, 1896. labor and make personal sacrifices not for financial returns alone, but because we have a high ideal of duty for which we are glad to make our sacrifices and accept as a reward the knowledge that our work has been well done and that man's life on earth has been made easier, his sufferings less because we have lived. What higher ideal can a man have than the sacrifice of self to the good of others. The happiest man is not he who goes to bed at night and says, I have made so many dollars to-day, but it is he who can say, some one is better off and happier to-day because I live. And this, gentlemen, is the glorious opportunity which presents itself to us, and is the reason our noble profession stands in a peculiar position to the rest of mankind. The rush of progress is so great and the practical side of human character is so largely developed in these the closing years of the nineteenth century that I thought it wise to address you upon a technical subject. In selecting the subject, I have endeavored to present one which is embraced in your line of work, viz., a review of the symptoms, diagnosis and indications for treatment of acute intra-abdominal injuries without external evidence of violence. sur The general and the railroad surgeon have many interests in common. Railroad gery being embraced in general surgery, it is impossible to draw lines of distinction. This is a fitting opportunity for me to raise my voice in protest against specialism in surgery. I have always maintained that the general surgeon whose opportunities have enabled him to deal with the various intra-abdominal affections, be they the result of disease or traumatism, occurring in the male or the female, is the more capable from his training than is the specialist, strictly speaking. The diagnosis and the indications for treatment in the majority of cases of railroad injuries are comparatively simple, and seldom occasion much doubt as to the proper course to be pursued. The cases of severe railroad injury, which constitute an exception to this statement, are those in which there are both profound shock and extensive laceration of the soft tissues with free hemorrhage. I do not agree with those whose practice it is to amputate under these circumstances, with the belief that the presence of the mangled member is a factor in prolonging the shock, and that, therefore, it is necessary to remove it before reaction can be established. I do not believe it to be good surgery to amputate at this time. Amputation during shock will never establish reaction, and bleeding can always be controlled by ligature, an Esmarch tube, or by a tourniquet. In intra-abdominal lesions I would only operate during shock where I believed free bleeding was going on. Opening the abdominal cavity for the purpose of controlling bleeding in the presence of shock, cannot be compared, from the degree of severity, with the removal of a limb during severe shock in the absence of uncontrollable hemorrhage. I emphasize this point, as I am sure it is a very important one. I consider that it is in the class of cases to which I am now referring that mature judgment is called for, and this is especially true of those accidents embraced in the title of this address, as there is no type of injury which calls for a more prompt diagnosis as to the probable result of the traumatic forces brought to bear and where immediate operative treatment is so urgently demanded. The free bleeding which occurs when an abdominal viscus or vessel is torn or ruptured is a sufficient indication for radical measures, and when we realize that peritonitis follows invariably and will probably be purulent in a few hours, we cannot hesitate to state that early section is the proper measure to pursue. Contusions of the solar plexus and splanchnic nerves will give rise to symptoms which may be misleading, but which should not long puzzle the experienced diagnostician. The arrangement of the bony and muscular anatomy of the abdomen peculiarly protects its contained viscera from the effects of trauma, but it is easy to comprehend how a slight accident may produce grave injury to its contents, when we consider the nature and the importance of the organs, their large vascular supply, their superficial location, and the likelihood of fatal hemorrhage and shock following an injury to any of them. The forces which cause these injuries are percussive, concussive and crushing. The injuries produced by percussive force are rupture of the solid viscera, and of the hollow viscera when filled with solid, semisolid, or fluid matter. Concussive force causes rupture of the mesentery |