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time permits indecision. Now if it hath power to select and reject, is not this power a seeming judgment or reason? Ovid said: "What
is reason now was passion formerly." But to me it is better said, What is reason now, was instinct then. Nay, then, with the loss of will comes instinct, with a deep flow of instinct is the loss of will and reason. Yea, reverse it, with the loss of instinct doth the beauty of and grandeur of reason and will come. Reason is not only the glory of human nature; yea, sadly so 'tis the voice of disease-yea, a mental infirmity. True, it is reason, and at times is not only a rebel unto faith, but it is a rebel unto anything else, for of it is that reason only comes from what a mind sees. What it sees is affected, not only by the conformation of a brain, but a defect in its function, the mind. Hence the most thou canst make of reason is that it is a slave of mental perceptions, and mental perceptions are all, indeed, guided by the normal or abnormal condition of the brain. So that when thou gave undue distinction to this faculty thou were, indeed, mislead; because to my mind reason has less stability in it than will, than memory, than passions themselves. For it is true as fate, that reason is more a creature of the past than it is of the present; and I for one believe that reason should not assume the broad function given it. While I may not agree with Luther in all things, yet 'twas well said when Luther remarked: "Human reason is like a drunken man on horseback, seated upon one side he tumbles over on the other." Reason is the force of a past, a hereditary transmission more than it is a modern and perfectly competent force.
Will has then the zenith of virtue over and above reason. At times it is true that in its action from result instinct is more perfect than reason. Thus saith Morrell: "True reason and intuition hold a similar relation to the understanding that perception holds a sensation." Intuition may mean a distinct inspection of the mind, a positive and direct apprehension of knowing an act and an immediate knowledge. If I may so say, in perception and consciousness distinguished from immediate knowledge which hath not reason in it. Yea, still better must I say, a truth discovered by direct knowledge, especially first or a primitive truth that cannot be acquired, but
is assumed in experience. Now, then, this assumption of experience cannot explain for an instant the intuitive knowledge of a child; for experience it hath none, at least greatly so, as far as the present is concerned. So that if this babe has an intuitive knowledge of things, objects or persons, which we will admit for the sake of argument is only now and then manifest, it must then be the knowledge which it hath gleaned from its ancestors and which has not been gleaned by itself.
Now, then, if Morrell's assertion be true, that pure reason is intuition, then intuition can only be the result of hereditary transmission, and perchance from what we know closely akin to instinct. Nay, upon my soul, ponder as I may, let me grind the molecules of my brain in their infinite cells, still will I maintain that intuition is a force, utterly inexplicable and seems to be the absolute basis of all deduction. Now, then, let us argue a little further on Morrell. He says that pure reason (and pure reason must be the best of reason over and above common reason) is intuition, and that it bears a similar relation to the understanding that perception holds to sensation. Now, then, sensation is but the irritation of a nerve-its action comes from intuition. Perception is but the action of the brain on this irritation, wherein it analyzes, recognizes and determines the character of the irritant; that is, it perceives what has been the cause of the irritation. Now, then, intuition is more than this to my mind. It conveys to the soul the modern and immediate conception, along undoubtedly with a hereditary impress of all those which have gone before it. Nay, upon my troth, think as I may the intuitive process of the brain or the action of perfect reason, if I may so style it, of a brain is what is beyond the present, as it holds within its embrace the entirety of the past. Then, if all reason is retrospective, it consists in applying facts and principles previously known; then is it not true that intuition is but the speaking voice; which impulsively proclaims from some God-given source the wondrous effect of heredity transmitted to a living present.
Now, then, gentlemen, with this I end, and if I have dragged you from the realm of what perchance I may wrongly accuse you of, that is, only the consideration of a dull metallic
commercialism in your future to the wonders of a God-given soulful force, which each and every one of you possess within the realms of a shapely calvarium, then I have accomplished my aim. But I am thus led to predict that the person who looks only to the gilded side of success rarely attains it. For it must ever be that the unconscious, dutiful, studious man, who ever strives to constantly replenish his mind through study, who follows sincerely the true function of his vocation, has within him the brainful power of obtaining the truest element of future reward.
My worthy, yes, my gracious student friends; let me in these fulsome, fleeting moments
That whilst thou art happy, hopeful, young,
and health is kindly, truly thine--court frugality.
Yea, impress labor upon thy mind; strive, toil thus thine own honored merited triumph bring;
Make thy mind ply as an honest, industrious
force; yea, a devout soulful powered thing. Thy brain is God's greatest, rarest gift. Yea, for divine growthful, noble purpose was given thee;
If errant use sadly marks its course, it will in surety bring thine own anguished misery.
Heavens! in all life there cannot be a fate more
truly sad, abject, benumbed, aye forlorn, Than when an idle brainful man becomes a thing for pity; yea, a thing of scorn. Nor does there bide upon our great wondrous earth a more worthy, grander entity, Than that man who hath to his function been true;
Thus become a man of use and mastery.
Aye, unbare thy arms, close shut thy jaws; hold thyself, thy head erect and earnest pray,
Gracious God! give me power, give me strength to be thy honored, worthy soul of capability.
I seek not praise, I seek not flattery, nor the harrowing, throbbing pangs which ambition brings;
But, my gracious God, grant me healthy functions, yes, broadened use; yea, kindly duties, happenings.
I crave neither power, pomp nor wealth, but earnest crave that glorious perfect function my brain enshrine;
For then, truly, surely do I know, if my soul be strong, that a glorious world is mine. Laparotomy in Contusions of the Abdomen.
M. Aimé Guinard (Paris) referred to three cases, two of blows on abdomen and one of stabbing, in which he did laparotomy. Of the first two, one was the result of a blow from a heavy joist, the other from the violent kick of a horse, in both of which laparotomy revealed rupture of intestine and escape of contents into peritoneal cavity. But he had not received either case until thirty-six hours after accident, and both were fatal. His third case, however, had immediate laparotomy for a knife-wound in the left groin, received in an affray right in front of the hospital. He sutured two perforations of small intestine and a large tear of the omentum, whereby a considerably artery bled copiously. Healing resulted in a few days, though no drainage was used. He attributed success to the early operative interference, and said: "I call attention to two symptoms which appear to me most important in diagnosing perforation of the intestines in case of contusion of the abdomen: First, the prehepatic tympanic sonorousness; second, rigid contraction of the abdominal muscles, completely preventing all deep manual exploration." He advises small exploratory opening, which is to be extended if gas, feces or blood be found, and which may be immediately closed without detriment if the peritoneal cavity is found intact.
M. Demons thought a light contusion or existence of shock would contra-indicate such interference, at least until reaction had set in, in the latter case.
M. Reclus protested against the exploratory incision, and insisted on the larger laparotomy if interference was made, as he thought it would have to be in most cases.
M. Demoulin related a case of wound of the abdomen with escape of omentum so as to hang down in front of the right hip. A laparotomy showed the existence of a hematoma of the cecum, caused by the same instrument that had let out the omentum. He ligatured two bleeding arteries and the patient recovered.
M. Reboul (Nimes) gave the case of a three
year-old child whose left flank was cut open about two inches by falling on a broken glass bottle, causing hernia of the greater part of the small intestine impossible to reduce, whose folds were reddened and glued together. He covered the hernial bundle with antiseptic dressing, and had the child taken to the Hôtel-Dieu, where he operated one and a half hours after the accident. At the moment of operation, besides the small intestine and mesentery, the omentum, colon and stomach had pushed through the wound. He anæsthetized and increased the opening to accomplish reduction. There being no deep lesions and no intestinal perforation he replaced the extruded organs as soon as he had properly cleansed them, though they were deeply injected and agglutinated by filamentous adhesions (from peritonitis). He sutured the walls with three rows of sutures, applied ice, had normal sequel and perfect union. He said: "I insist on the rarity of this case, its gravity, the importance of early interference and the cure we can effect in these cases though peritonitis has already set in."-Progres Medi
Trumatic Rupture of the Liver.
In the Australasian Medical Gazette, Dr. Someren reports a fatal case of hepatic rupture: A woman, aged thirty-six years, married, nullipara, was seated on a cart, next the driver, passing along a main road, when the driver found it needful to turn off the siding on to the road, and in doing so the cart was tilted suddenly and acutely to the side of the driver. The woman fell against the driver, who, seated on the extreme edge and unprepared, jumped off, thus removing the expected support from the woman, who then rolled helplessly and in a heap off the dray, and fell on her head, while her body lay just across the wheel track. By this time the dray had got on to the crown of the metalled road, and here the wheel went over her abdomen, she lying on her back. She was taken up and put on the dray, supported in a half-reclining position. A little blood issued from her mouth. She made the remark, “I feel faint," and lapsed into unconsciousness. The dray came back to a hotel, about three hundred yards from the scene of the tragedy, and she was taken out and put on a bed, and there she expired very shortly after. It should be mentioned that she seemed at first not to be breathing at all, but just before getting to the hotel she began to breathe better and more perceptibly. The doctor arrived upon the scene very soon after her death, which occurred within half an hour of the accident. There was a very superficial abrasion upon the forehead, just at the parting of the hair, and this was the only mark upon her person any
where. Pallor was great, but not strikingly marked. From the history he judged that death was the result of rupture of an abdominal viscus, probably the spleen or the liver; but the statement that blood had issued from the mouth made him doubt whether the fall on the head might not have produced some rupture of a cerebral vessel. The coroner ordered a post-mortem. The doctor proceeded to open the abdomen first of all, prepossessed by the idea that he would discover there the cause of death. Beginning with the median incision, he then made a transverse one from the xiphoid cartilage to the right flank, and reflected the flap downward and outward, laying bare the right hypochondrium, and in the course of this came across a blood extravasation in the adipose tissue, which was most abundant, in some parts as much as an inch in depth. This extravasation was just at the edge of the cartilage of the ninth right rib. Further reflection disclosed a fracture of the ninth right rib, the posterior portion overriding the anterior. Opening the peritoneum, he came upon an enormous effusion of blood, and, raising the thoracic wall, the liver could be seen with several rents in Glisson's capsule, which seemed to proceed radially from posteriorly, principally in the right lobe. Passing his hand around the liver between it and the ribs, he ascertained that the overriden fragment of the fractured rib did not penetrate internally at all. Then pushing the hands over the convex surface of the liver backward, he came upon a pulpy mass of liver, merely held together by fibrous shreds. Almost the whole posterior border of the liver was thus macerated, including the whole right lobe and a geater part of the left. The capsule was stripped off in all directions. The mass of blood was enormous. No other organ whatever was in the least injured, though all, naturally, were exsanguine. The concave surface of the liver was comparatively uninjured anteriorly and inferiorly; all the vessels, afferent and efferent, being intact. Approximately speaking, quite half the liver was broken up, and apparently this was accomplished by the posterior portion being crushed against the angle of the ribs and spinal column, and there macerated by the force applied anteriorly and from the right side externally. How a viscus with the characteristics of the liver could be thus extensively, deeply and thoroughly injured, under the shelter of the ribs, by a force roughly calculated as equal to half a ton, and yet not the slightest abrasion or mark be present upon the skin evento indicate that such an external force had been applied, seems a problem in vital dynamics which calls for solution. The woman had on loose but fairly good corsets, her other clothing being of a very flimsy, slight character.-Medical Record.
Officers of the N. A. R. S., 1896-7.
F. J. LUTZ, St. Louis, Mo.
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.
THE TENTH ANNUAL CONVENTION.
The tenth annual convention of the National Association of Railway Surgeons-or the "International Association," as it will henceforward and rightly be called-was a pronounced success. The attendance was excellent. The papers and discussions were of a very high character. The meeting was harmonicus. The weather was glorious and, finally, the registration of members for the ensuing year was very much in excess of the number who registered last year at St. Louis. According to custom we shall not commence the publication of the official proceedings until the first issue of our new volume, which will be our next issue, to be published on June 1. Meanwhile it is sufficient to say that the election of Dr. George Ross of Richmond, Va., to the presidency was an action in which the association did itself credit, and the
decision to meet next year in Toronto was a wise and graceful recognition of the interest which the Canadian members have always shown in the affairs of the association. A novel feature of the convention this year was the daily edition of The Railway Surgeon, which was published each morning during the sessions of the convention and which has already been received by our readers. This was the first time that any medical or surgical convention has had a daily paper published exclusively for its benefit, and it undoubtedly contributed something to the success of an eminently successful meeting.
We cannot close this, the third volume of The Railway Surgeon, without some reflections relative to our past and some hopes for the future. We believe that the members of the National Association of Railway Surgeons will forgive us if we express some pride in our official journal and in the improvement of the paper during the past year. We also believe that all will agree that The Railway Surgeon is a valuable aid to the Association, not only in disseminating among our members the facts relative to traumatic surgery, which are developed at our meetings, but in giving railway surgery and our National Association a standing in the profession and with the railways.
We hope that the new interest shown in The Railway Surgeon of late may prompt the members of the Association to a fuller realization of the fact that it is their journal and that by their individual efforts, as well as by their united action as an association, they can do much to make it a still better and more useful paper.
The columns of The Railway Surgeon are at all times at the disposal of our readers, and while we have never yet lacked material with which to fill its pages, we again solicit papers, reports of cases, correspondence, and all matter of news relative to railway surgery or other matters of interest to our readers.
THE CHOICE OF AN ANESTHETIC.
In another column we publish an excellent paper under the above title by Dr. A. I. Bouffleur of Chicago. We do not recall a more logical exposition of the subject and
heartily indorse Dr. Bouffleur's conclusions. The subject of the paper is of vital importance to everyone who is ever called upon to give an anæsthetic or to operate upon a patient who must take one. We are sorry to say, however, that it is a matter which too often receives no thoughtful attention whatever. The statistics which are so favorable to ether have unquestionably done much harm by inducing its general adoption by some surgeons, and in some hospitals, to the exclusion of chloroform, which, as Dr. Bouffleur points out, is obviously safer in many cases. It is also true that when all deaths really due to ether are accredited to it and chloroform is given only in properly selected cases and by approved methods, the statistical tables will look very different.
We also wish to endorse Dr. Bouffleur's plea for the recognition of the professional anææsthetizer, which we have repeatedly urged in these columns. We shall never feel that all has been done to make anesthesia safe until only skilled persons are entrusted (except in emergencies) with the important duty of putting people to sleep.
Correction of Deformity Caused by Colles' Fracture.
At a recent meeting of the Practitioners' Society of New York, Dr. McBurney presented a boy of about sixteen years, to show the result of an operation for the relief of deformity and impaired function caused by a Colles' fracture of the radius, one and onehalf inches from the lower extremity. Perfect union had resulted after the fracture, with well-marked silver-fork deformity, loss of power of flexion at the wrist, partial loss of flexion of the fingers, a good deal of pain on motion. While recognizing the importance of doing something to give relief, he did not think he could with propriety attempt refracture without a cutting operation. Cutting down upon the bone, he divided this as nearly as he could in the line of the fracture, which ran somewhat obliquely. He was then able to put the parts up in proper position and retain them with a plaster-of-Paris splint. The splint had been removed a week since. There was very little deformity left, and the restoration of function had been extremely satisfactory. Replying to an interrogatory by Dr. Dana, he said the nerve had not been injured, but simply stretched by the displaced bones. Dr. McBurney added that it was common to see cases of this deformity, the doctor being
apt to tell the patients that disability would gradually disappear. But it did not, and they went on indefinitely with great loss of function. The deformity was nearly as common as that left by Pott's fracture, and that was very common.-Medical Record.
Iodoform-Calomel in the Treatment of Wounds
The results obtained in the treatment of wound-surfaces and cavities that are difficult to disinfect or from which it is difficult to eradicate completely a disease are detailed by Sprengel (Cent. fur Chir.) who has found this combination especially efficacious in the treatment of tubercular wounds and in tracheotomies necessitated by diphtheric membranes.
If this mixture is strewn upon a fresh woundsurface, after a short time it assumes a grayish appearance, undoubtedly due to an eschar produced by the caustic action of the drug. In a few days this will fall off and be followed by bright healthy granulations.
A chemical analysis of the compound produced shows that the action of the wound-secretions forms a biniodide of mercury from the combination, which is a very powerful antisep
The action of this salt of mercury is not the same if applied by itself, as poisoning may ensue, which does not when the two drugs are combined, as the soluble salt of mercury is only produced in proportion to the secretion of the wound.
The author applies the powder by shaking a curetteful into the wound and then rubbing it thoroughly about with a hæmostat covered by a ball of gauze. A previous thorough drying of the wound is necessary, which can usually be accomplished by packing the wound with sterilized gauze and letting it remain for a few minutes. The powder is then applied and the wound packed with gauze. The author finds that the removal of the packing is greatly facilitated by the slough which forms, as there are no adhesions of granulations to it and the patient has little or no pain when the gauze is removed three or four days later.
In tracheotomies the powder is strewn over the inner surface of the trachea, between the diseased area above and the wound and healthy tissue below. This procedure the author has found greatly hinders the spread of the disease and prevents infection of the wound. In 200 cases he has had 45 to 60 per cent. of recoveries.
The amount of powder employed varied with the case and the age of the patient. He has used a drachm of the mixture without seeing any serious results, and has employed suppositories and balls of the mixture in cocoabutter in sinuses and cavities without seeing any harmful results.-Amer. Jour. Med. Sciences.