« ForrigeFortsæt »
Case I.-I. K., a switchman on the Missouri Pacific railway, aged 51, while engaged in
Notes, News and Personals. switching cars, inadvertently stepped upon the
The Missouri Pacific Railway Hospital Department treated, during the year ending December 31, 1895, 29,109 patients; 439 were inpatients; 24,370 were out-patients.
In the St. Louis Division 21,037 patients were treated, and in the Kansas City Division 8,434.
The St. Louis Division supplied 56,226 prescriptions.
The Kansas City Division supplied 25,789, making a total of 82,015.
The Missouri Pacific Railway Hospital Department, during the first six months of 1896, has treated 1,654 in-patients and 6,907 outpatients and filled 22,342 prescriptions.
The St. Louis Hospital of the Missouri Pacific Railway Hospital Department was injured by the recent cyclone, which occurred at St. Louis May 27, to the extent of about $6,000. The rear wall of the administration building was demolished; the summer ward, and a portion of the stable were wrecked. The entire roof of the building was curled up and blown off. Fortunately, none of the occupants of the hospital were injured, but its staff was left in a somewhat uncertain and nervous state of mind. This staff is now rapidly becoming well acquainted with meteorology; the character of the clouds is now carefully noted, and every member of the staff appears to be informed about circus cum ulus stratus, nimbus and circo-stratus-cumulus stratus. Now it only needs a dark green, sickening looking cloud to suggest to them the pleasant confines of a cave or tunnel, or, as was said, a “deep underground tunnel." A man by the name of Smith said that, "clouds were those playful fancies of the mighty skies;" but, as one of the staff suggested, there are not a few Smiths in St. Louis who would say that, instead of clouds being fancies they were mighty facts of the mighty skies, and that he was morally sure that cyclones never played; they are too deeply in
Should any man argue that a physician understands his own art best and therefore, although he should prescribe poison to all his patients, he cannot be justly punished, but is answerable only to God?-Swift.
track while looking in a direction opposite to that from which an engine was coming, and was knocked down, the tender of the engine passing over him. The statement of the patient in his own words may be instructive and interesting. He said: "When I was struck I was thrown upon my back, and as quick as lightning I knew that I was a goner if the firebox of the engine should pass over me. I threw my legs up and put my feet against the firebox and was pushed backwards upon my back, as it seemed to me, a hundred feet. I felt my back crack and that it was being scraped all to pieces, still at no time did I lose my head, and no one ever wanted anything to stop moving any more than I did that engine."
The patient was brought into the hospital three-quarters of an hour after the accident, and upon examination did not present evidences of excessive shock. There was a partial dislocation of the eleventh dorsal vertebra; the separation between the spinous process of the eleventh and twelfth dorsal vertebræ was nearly an inch in extent; motion and sensation were normal in both extremities, although there was retention of urine, probably due to shock, as he was able to pass the urine readily six hours afterward. His back was contused and more or less lacerated from shoulders to buttocks, caused by being scraped over ties and cinders. He had also had several scalp wounds. The patient was put upon a water bed and improved rapidly; upon the fourteenth day a plaster-of-paris jacket was applied. This jacket was kept on the patient for nearly four months, experience in these cases indicating that a too early removal may be deleterious. He was not permitted to resume labor until nearly six months after the accident. He has since returned to lighter labor, as in almost all of these cases a more or less degree of rigidity of the vertebral column remains as an heritage to this form of
injury. There are few if any of these cases where we have a perfect return to normal action and elasticity. After the plaster jacket had been removed massage and systematic exercise were ordered.
SYNCHRONOUS AMPUTATION OF BOTH LEGS.
Case II.-I. M., a section hand on the Missouri Pacific railway, aged 54, was knocked down by an engine and run over, sustaining loss of both legs. The right leg was crushed at the junction of the upper and middle thirds, the left was crushed near the junction of the lower and middle thirds. He was brought to the hospital within half an hour after accident. Upon examination he was found to be suffering from excessive shock, the pulse was rapid and very weak, but the mind was clear and he answered questions intelligently. Owing to the age of the patient the case was considered as doubtful. One-twenty-fifth of a grain of strychnia was given hypodermically every half hour, and a little over a quart of the normal saline solution was injected into his right flank. The pulse responded to these remedies, and after an hour and a half, amputation was performed. Dr. Outten and Dr. Vasterling synchronously performing the amputations, Dr. Outten on the right leg, Dr. Vasterling on the left. Shock was in no way excessive after the amputations, but the injections of strychnia were kept up at intervals of two hours for some eight or ten hours. This case progressed to recovery, with excellent stumps.
SYNCHRONOUS AMPUTATION OF BOTH LEGS.
Case III.-M. M., a section hand on the Missouri Pacific railway, aged 22, while engaged in dumping dirt, fell between cars and was run over. Being injured 54 miles out upon road, he was not received in the hospital until nearly six hours after the accident. Upon examination the right leg was found crushed at the junction of the upper and middle thirds; the left leg was crushed at the junction of the middle and lower thirds. In the infliction of the injury a contused and lacerated wound was made, which extended upon the outer aspect of the limb, four inches above the knee. The skin was separated from tissues beneath, almost up to the knee, and stretched to such an extent as to leave a doubtful skin flap. The muscles were pulpified upon the side of the limb. The patient was still suffering from
shock, and saline solutions were injected and strychnia given. Amputation was performed eight hours after the infliction of the injury, Dr. Vasterling amputating the right leg, Dr. Outten the left. After amputation the patient evinced greater shock and strychnia was administered every two hours. Eighteen hours after amputation reaction appeared to be complete. The case progressed steadily, but upon the outer aspect of the left leg a granulating wound was left was left some 18 or 20 square inches in extent, which showed no tendency to heal. The dressings were changed, aseptic gauze being steeped in a six-tenths normal saline solution. Under this treatment the wound seemed to improve, but desiring to hasten the healing process, the root sheaths of hair were used as grafts, and certainly aided in the healing proIt was found, however, that in the use of the normal saline solutions, when persisted in too long, the granulations become pale and anæmic, and the epidermic edges of the wound presented a condition of more or less inversion. It will be found that upon the addition of a dram of sugar to a pint of the normal saline. solution, that there will be an improvement in the appearance of the granulations inside of twenty-four hours. By changing thus from the saline solution to a saccharated saline. solution, these dressings certainly act as well, and, to our conception, infinitely better, than agents any antiseptic we have ever used. If a seeming sluggishness in the healing process Occurs under the use of the normal saline solutions, the free bathing of the granulations with hot aseptic solutions of salt and sugar certainly show the good effects. There were about twenty root sheath grafts applied, many of which took excellently well, and the wound has healed perfectly. Considering the great loss of skin, it is certainly a splendid showing.
There have been five double amputations synchronously performed in this hospital. One was where both arms were amputated simultaneously; the rest were where both legs were crushed; none of them, however, was above the knee, and to this fact we attribute the recovery of all of the cases. It is certainly the best of common sense to minimize the length of time that a shocked patient is under chloroform, hence in these cases where two operators are
employed at the same time, we shorten the operative time and diminish the amount of chloroform administered. If such cases will get well at all they certainly have a better chance with synchronous amputations. We would consider from our experience in these cases, that the performance of a double amputation by a single operator is a reprehensible proceeding, as it enhances the danger and is liable to be fatal. The points in favor of two operators are the celerity of the procedure and the relatively short time that the anæsthesia is used. These are always two vital points, where shock has been manifested.
COMPOUND COMMINUTED FRACTURE OF leg.
Case IV.-I. T., a laborer, aged 22, an employe of the St. L. I. M. & S. Railway, was riding on the pilot of an engine with his leg hanging over the side of the pilot. His left leg collided with a heavy truck on a platform, producing a compound comminuted fracture. The parts were dressed by a local surgeon, and a piece of the tibia removed nearly three inches in length. The patient was then brought to the hospital. Upon examination we found the fibula comminuted, but the circulation was well established, and it was determined that an attempt should be made to bring the fractured ends in apposition. The inferior fragment of the tibia being bevelled, this portion of the bone was sawed off, while the superior fragment being rather blunt, it was determined to engage the upper fragment in the medullary cavity of the lower. The superior fragment of the fractured tibia was therefore chiseled upon both sides, making it somewhat pointed. The comminuted pieces of the broken fibula were removed, thus rendering it possible to bring the fragments of the tibia in apposition. A hole was then bored in the lower fragment of the tibia, and a similar one in the upper; notches were made in the bone, half an inch above and below these holes, respectively. Large cable silk, rendered aseptic, was then introduced through the holes and the superior fragment of the tibia with its sharpened point was engaged in the medullary cavity of the inferior portion. The silk cable was tightened and engaged in the notches above and below the holes through which it passed; the consequence was that a comparatively firm apposition of the fractured ends.
of the tibia was obtained. Campho-phenique had been used in cleansing the parts. They were then washed with the hot normal saline solution and covered with gauze steeped in saline solution, and a cinnamon bandage applied outside, after which the limb was put in a wire basket splint. Union is slowly taking place. Under this simple dressing there has been but little suppuration, less than we have ever seen from so extensive an injury.
AMPUTATION OF LEG IN THE MIDDLE THIRD.
Case V.-A. B., a brakeman on the St. L. I. M. & S. Railway, aged 53, while attempting to get on a car, slipped and fell, his right leg passing under the cars, crushing his leg nearly to the junction of the lower and middle thirds. B. is an unusually large and fleshy person, and the difficulty encountered in this case was the saving of as much of the limb as possible; but owing to the unusual circumference of the calf of the leg it was difficult to determine the true condition of the skin. A modified Stephen Smith flap was made. The skin around and above the point selected for amputation was thoroughly scrubbed with hot water and soap and a corrosive sublimate solution (1 in 1,000.) After amputation the normal saline solution was used and aseptic gauze steeped in hot normal saline solution applied to the parts to the amount of three layers, then a gelatinous cinnamon gauze bandage applied. Above this, another layer of salted gauze, and above this the cinnamon gauze completed the dressing. A posterior wire splint was adjusted to carry out still further the treatment of rest. This case is mentioned mainly to show the fact that treatment under salted and cinnamon gauze resulted in healing by first intention. All wounds in the St. Louis hospital are now being treated by the saline solution, and the cinnamon impregnated gauze bandage. Since we have employed this treatment, we have obtained better and more satisfactory results than we did when we used the usual antiseptic dressings. There is absolutely no odor about the dressings and there is comfort in the application, not only to the patient, but to the surgeon as well. Iodoform, corrosive sublimate and carbolic acid are never used in dressing wounds now; nothing but saline solutions, gauze and cinnamon bandages. Hence there is never any dread of either local or sys
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 cccurred upon inner aspect of the thigh ad upon the penis and scrotum. While both were somewhat severely injured, yet under treatment they are doing well.
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. he 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
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 with, but remembering he had some matches and and a pocket handkerchief, he after some difficulty managed to set fire to the latter, and was ena-bled 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.
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 Extracts and Abstracts.
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 cedema, 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.
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.
Lord Byron somewhere says: "Strength of endurance is better than all talent." To which an unknown wit responded: "If this axiom be true, how superior an animal is the ass." Granted that the ass is superior; but it is an established fact that the ass was invented a long time before the bicycle. But the "Biker" could dally and endure all around a solitary ass. If he humped his back at the right angle he could wear out a drove of long-eared talent.
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 statethat alcohol has really a bactericidal property which, however, is able to exercise its action only under certain circumstancesnamely, 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