those due to hysteria, neurasthenia and malingering, where a history of accident is undeniable. SYMPTOMS OF SPINAL CORD INJURY. These are variable in extent, depending upon the location and extent of the lesion. An injury to one segment deranges or abolishes the functions of all segments below it, while all or only a part of the functions of the cord may be affected, according as the injury involves the whole or only a part of its transverse diameter. Paralysis, usually bilateral, at the outset coincident with injury or shortly afterward, is the rule. At first the affected muscles are flaccid, later they become contractured. Atrophy of the muscles, due both to want of exercise and to disturbance of the trophic functions of the cord, occurs. Reaction of degeneration obtains as a rule. The muscular reflexes at first are lost. Whether they will return or even become exaggerated depends upon the altitude of the lesion. The functional reflexes become deranged, and there is consequently retention or incontinence of feces and urine. Priapism is frequent. Bedsores, cyanosis and coldness of extremities are due to trophic and vasomotor disturbances. Pain either at the site of the injury or radiating down the trunk and lower extremities may or may not be present. Cases have been observed in which it is of the most excruciating character, while others again with the gravest injuries complain very little or not at all. Anesthesia is regarded as a symptom of the highest diagnostic value. It has been shown that the distribution of anesthesia due to spinal cord injuries is entirely different from that caused by injury to the brain or to the peripheral nerves, or from that observed in hysteria. When cutaneous sensibility is lost, as it almost always is in these cases, the topography of the anesthesia may be confidently relied upon to furnish a means for the determination of the highest spinal cord segment which has lost its power of transmitting sensory stimuli. A transverse lesion of one segment involves a loss of conductivity in all the segments below it. The extent and distribution of the various clinical manifestations differ with the extent and character of the lesion. If the cord has been seriously bruised, or if extensive hemor rhage has occurred, the resulting symptoms promptly appear, and are then those of a transverse lesion. If the damage to the cord has been slight or partial, the symptoms may be somewhat delayed in appearing. Anesthesia is always present in severe injuries, but when the other symptoms indicate only a partial lesion anesthesia may be entirely absent. The character of the lesion in injuries to the spinal cord may be correctly inferred if there are evidences of fracture of the vertebræ. It is when there are no external indications of injury to the spinal column that it becomes difficult to determine in what way the function of the spinal cord has become impaired or lost. We are then unable to distinguish between compression by bone or hemorrhage. We only know that hemorrhage is particularly frequent in the cervical region, and that a gradual extension of symptoms may be due to blood finding its way up or down the cord. Odd Fellows' Building. FIRST AID IN RAILROAD INJURIES.* G. B. THORNTON, M.D. Local Surgeon Illinois Central R. R. and Southern Ry. THE above caption being a subject assigned me for a short paper by your Secretary for this evening's discussion, I will offer a few views and suggestions incident to a number of years experience as local surgeon for two of our railroads. In many of the injuries the first aid should be addressed to the alleviation of pain, and providing against the dangers from shock and hemorrhage. There are no cases of an emergency character where shock is more frequently met with than in railroad injuries. Many such injuries are of a sudden and violent character, hence shock more or less pronounced is of frequent occurrence. The hemorrhage worthy of mention incident to these cases being as a rule from contused and lacerated wounds, is of a more passive character than if from clean cut or incised wounds, and is also retarded by shock before reaction is established. All hemorrhage should be * Read before Memphis and Shelby County Medical Society, Sept. 1, 1903. immediately controlled by either pressure or ligation of bleeding vessel, the wound cleansed and the best available temporary dressing applied. The practical question of what constitutes first aid, assuming that this is on first visit to patient, at or near the place of accident, on the side of the track at a wreck out on the road, in the yard or at a way station, is to alleviate pain and guard against immediate danger from shock and hemorrhage, as before stated. For the first, the hypodermic administration of morphin, and putting the patient in the most convenient place and best position for his comfort. Serious hemorrhage should be controlled as quickly as possible by either a rubber band, tourniquet, or by compress and roller bandage. The ligation of bleeding vessels in an open wound is best, if practicable, before the patient is moved; this insures more positively against recurring hemorrhage when reaction sets in and is safer in transit. The shock in these cases is due wholly to physical injury and is manifested by cardiac depression and impairment of the respiratory and senorial functions and reduction of surface temperature. It not infrequently happens at the first visit that the patient is found with a weak, thready pulse, sometimes imperceptible at the wrist, and the whole body surface is cold and clammy. While dangerous shock may exist without hemorrhage, railroad injuries are most frequently associated with it, and loss of blood augments the degree of shock. This complication adds greatly to the danger, as the vital forces are impaired by the loss of blood. It is in this class of cases, those complicated by the loss of blood almost to exsanguination, where the normal salt solution used directly in a vein has its quickest and most beneficial effect. I can speak of this positively, as I have had occasion to use it in several cases where to all appearances it was lifesaving. It is not always at first visit, possibly made at night, and in inclement weather, on the roadside or at a way station, that this restorative can be used. The immediate work is to reëstablish the functions of the heart, when this organ shows dangerous weakness from shock, with or without hemorrhage, and convey the patient as speedily and safely as possible to his home, or preferably to the hospital for operation, or to administer such treatment as the case demands. For supporting heart action, the hypodermic administration of strychnia, nitroglycerin or digitalin, are the remedies of the hypodermic case carried by all doctors for immediate use. Adrenalin, the product of the suprarenal glands, is the latest, and from a number of recent accounts in the medical journals, the best to restore action and relieve blood pressure. It is claimed for this remedy that it is the most powerful styptic and heart stimulant known. My experience with it has been limited to a few cases of minor surgery as a styptic with satisfactory results, but as a heart stimulant to relieve blood pressure in place of strychnia or nitroglycerin, I cannot speak from personal experience or observation. In the majority of cases of railroad injuries the principles and practice of minor surgery are applicable and require no special comment here. In case of fracture the injured limb should be placed in a padded or covered splint and held in position as immovable as possible. The most comfortable appliance for fracture below the knee is an ordinary feather or cotton pillow, held firmly around the limb by a bandage or cord. This is also a good temporary dressing for such fracture in place of a fracture box or sand bags prior to the application of the more permanent or final treatment by plaster of Paris. For the handling and removal of these cases from a railroad station or place of accident, Memphis now has good ambulance facilities. Several of the undertakers each keep a first class modern ambulance subject to call, with which two men go, the driver and an assistant, which greatly facilitates the moving of emergency cases, whether from railroad injuries or otherwise. The city hospital has a good ambulance service which I wish especially to commend, as I have had occasion to use it in my railroad practice a number of times. An intelligent young doctor, one of the hospital internes and a graduate of our local medical college, goes with the ambulance whenever it is called out, and on several occasions, to my knowledge, has rendered valuable service in giving first aid by alleviating suffering at or near the place of accident, and promptly removVol. 23-39 ing the patient to the hospital. This service I think is limited to those cases that are carried to the city hospital. To discuss the treatment of cases of railroad injuries after being received at home or hospital would go beyond my present thesis. I will take occasion to say, however, it not being irrelevant, that at least a returning reaction from pronounced shock should be established before any capital operation is done. All vessels of any considerable size in open wounds or crushed limbs should be ligated and heart action reëstablished as far as practicable before operating. PROGRESS OF MEDICINE. MEDICINE. UNDER CHARGE OF B. F. TURNER, M.D. Visiting Physician St. Joseph's Hospital. Recent Inoculation Experiments with Different Tuberculous Material. At the Berlin Medical Society recently, a report was given of experiments made at the Reichsgesundheilsamt (Berlin Cor. Med. Press & Cir., vol. 77, no. 3355). First, pure culti vations were made, the skin forming on the bouillon was weighed, washed with water, and though in all instances brought to the same degree of concentration, the mass should always be uniform. Perlsucht bacilli from seven sources were experimented with, and with six of these a typical, grave disease, generally ending fatally in two or three months, was set up. These cultivations were made from nineteen cases of tubercle of the lungs, partly from the sputum and partly from the tissue, and only seven cases were made use of. If injection with these bacilli were made, infiltration took place at the point of inoculation, but distinctly smaller than when perlsucht was used, and after some time the part improved. There was no fever. The adjoining lymph glands swelled, but never to the size of a goose egg. If the animals were killed after four months, bacilli still living were found at the point of inoculation, the lymph glands were but little if at all enlarged, |