tion of the subject and its perusal will prove profitable to either the student or the specialist.

EDWIN PYNCHON.

"International Clinics." A Quarterly of Illustrated Clinical Lectures and especially prepared Articles on Medicine, Neurology, Surgery, Therapeutics, Obstetrics, Pediatrics, Pathology, Dermatology, Diseases of the Eye, Ear, Nose, and Throat, and other Topics of Interest to Students and Practitioners by leading Members of the Medical Profession throughout the World. Edited by Henry W. Cattell, A. M.. M. D., Philadelphia, U. S. A., with the Collaboration of John B. Murphy, M. D., Chicago; Alexander D. Blackader, M. D., Montreal; H. C. Wood, M. D., Philadelphia; T. M. Rotch, M. D., Boston; E. Landolt, M. D., Paris; Thomas G. Morton, M. D., Philadelphia; James J. Walsh, M. D., New York; J. W. Bailantyne, M. D., Edinburgh, and John Harold, M. D., London, with Regular Correspondents in Montreal, London, Paris, Leipsic, and Vienna. Philadelphia and London: J. B. Lippincott Company, 1902. Cloth, $2.00 per volume. Eleventh series Vol. IV. Twelfth series Vols. I and II.

Vol. IV. contains 31 articles on therapeutics, medicine, neurology, surgery, pediatrics, dermatology, besides a special article on keeping case records; Vol. I., 19 articles, in addition to 2 biographical sketches and a review of medical progress in 1901; Vol. II., 24 articles, besides a biographical sketch and three special articles.

It is difficult to pick out from this wealth of material any articles for especial commendation, but attention may be directed to the clinics of Prof. Senn and Deaver; the articles on Movable Kidney, by Lydston; Sympathectomy, by Jonnesco and the various special articles. Both specialist and general practioners will find something of interest to them. The volumes are profusely, and even lavishly, ilustrated.

"A Brief of Necroscopy and Its Medico-Legal Relations." By Gustav Schmitt, M. D. 3x64 in., leather, 186 pp. New York and London: Funk & Wagnalls Company, 1902. $1.00

net.

There is no lack of trustworthy works on this subject, and if there were this brochure would scarcely meet the demand. We have never heard of the author as an authority on legal medicine, and as an example of the unsafe nature of the teachings we may refer to page 50, where we are advised to saw partly through in removing the calvarium, and "what remains unsawn can be readily cracked with hammer and chisel." While we are told to be sure further on, this should be refrained from if fracture is suspected, its use in ordinary cases inevitably leads to uncomfortable and even dangerous scratches.

There are three cuts referred to as "plates," one of the base of the brain, another of the viscera, the other of cerebral localization. The last is on so small a scale as to be practically valueless. According to the author, this one gives the physician "an immediate clue from the history of the symptoms, and thus guides him where to begin the section (head or abdomen)"! After an experience in several thousand necropsies the reviewer is forced to disagree with the author, and believes the space taken up by these cuts would have far better been devoted to some showing the method of opening the heart, or slicing up the liver, of keeping the calvarium. in place, etc. A clue to the author's method may be gathered from the preface, where, after acknowledging

his indebtedness, he informs us: "It was necessary to curtail at time, and, therefore, the articles are not a verbatim transcript of those of the authors."

"A Treatise on Diseases of the Skin." For the use of Advanced Students and Practitioners. By Henry W. Stelwagon, M. D., Ph. D., Clinical Professor of Dermatology, Jefferson Medical College and Woman's Medical College, Philadelphia; Dermatologist to the Howard and Philadelphia Hospitals. Octavo, 1,125 pages, with 220 text-illustrations, and 26 fullpage lithographic and half-tone plates. Philadelphia and London: W. B. Saunders & Co. Chicago: W. T. Keener & Co., 1902. Cloth, $6.00 net; Sheep or Half Morocco, $7.00

net.

The

The first 128 pages of this portly volume are devoted to: Anatomy and Physiology, General Symptomatology, Etiology, Pathology, Diagnosis and Treatment. consideration of the diseases in order is taken up next. Hebra's classification being followed. The sections are devoted respectively to Hyperemias, Inflammations, Hemorrhages, Hypertrophies, Atrophies, New Growths, Neuromas, Diseases of the Appendages, Parasitic Diseases, and a supplement on Diseases of Uncertain Origin. An index of 21 double columned pages finishes the work. Especial stress is laid on diagnosis and treatment and the work should prove indispensable to the average practitioner who is somewhat hazy as a rule on dermatology. The colored plates are all from Mracek, and their life-like character and excellence have already been pointed out in these columns.

PAMPHLETS RECEIVED.

"A Case Illustrating Plastic Surgery of the Eyelids," by Cassius D. Wescott, M. D., of Chicago.

"Further Report of a Previously Recorded Case of Blastomycosis of the Skin; Systemic Infection with Blastomyces; Death; Autopsy." by James W. Walker, M. D., and Frank Hugh Montgomery, M. D., of Chicago.

"Optic Neuritis in the Young, with Report of Five Cases." by William Cheatham, M. D., of Louisville, Ky. "The Rational Treatment of Movable Kidney and Associated Ptoses," by N. Ernest Gallant, M. D., of New York.

Notes of Societies.

AMERICAN ACADEMY OF RAILWAY SUR. GEONS.

The next session of the Academy will be held in Parlor "S" of the Midland Hotel, Kansas City, Mo., on Thursday and Friday, October 2 and 3, 1902. The Midland Hotel will be headquarters during the session.

T. B. LACEY, Secretary.

The following roads will grant transportation: New York, Chicago & St. Louis, Erie, Atchison, Topeka & Santa Fe, Chicago, St. Paul, Minneapolis & Omaha, Wisconsin Central, Union Pacific, New York, Ontario & Western, Baltimore & Ohio, Wabash, Norfolk & Western, Fremont, Elkhorn & Missouri Valley, Chicago & Great Western, Elgin, Joliet & Eastern, St. Louis & San Francisco, Missouri Pacific, Florida East Coast, Illinois Central, Mexican International, Southern Pacific, Oregon Railroad & Navigation Company, Chicago, Milwaukee &

St. Paul, Chicago & Northwestern, Great Northern, Plant System, for its hospital surgeons only, Canadian Pacific.

PROGRAM.

President's Address, "Negligence," A. F. Jonas, M. D., Chief Surgeon Union Pacific Railway, Omaha, Neb. "The Benefit of a Surgical Department to a Railroad," Ralph C. Richards, Esq., General Claim Agent C. & N. W. Ry.. Chicago, Ill.

"Responsibility of Railway Companies in Tuberculosis from Trauma," J. D. Griffith, M. D., Consulting Surgeon K. C., F. S. & M. Ry., Kansas City, Mo.

"What Is the Value of an Injury?" J. F. Pritchard, M. D., District Surgeon C. & X. W. Ry., Manitowoc, Wis.

"The Diet in the Treatment of Surgical Cases," A. B. Brumbaugh, M. D., Surgeon Pennsylvania Ry., Huntingdon, Pa.

"The Progressive Character of Surgery, and its Connection with Hygiene," G. P. Conn, M. D., Chief Surgeon Boston & Maine Ry., Concord, N. H.

"Penetrating Gunshot Wound of the Skull-Loss of Gray Matter-Function of Speech Lost and ParalysisTrephining and Elevation of Depressed Fragment--Recovery of Speech, and from Paralysis," L. Sexton, M. D., district surgeon Illinois Central Ry., New Orleans, La. "Some Persistent, and Not Entirely Explained Symptoms, Following Injury," R. H. Cowan, M. D., assistant chief surgeon Norfolk & W. Ry., Radford, Va.

"Emphysematous Gangrene," Webb J. Kelly, M. D., surgeon Big Four Ky., Piqua, O.

"Sanitation in Its Relation to Railway Problems," H. M. Bracken, M. D., secretary of State Board of Health of Minnesota, St. Paul, Minn.

D. "Compound Fractures, with Special Reference to Their Treatment," W. U. Cole, M. D., chief surgeon Hocking V., and T. & O. C. Rys., Columbus, O.

E. "Deformities, the Result of Fractures, and How to Prevent Them," John E. Owens, M. D., chief surgeon C. & N. W. and Illinois Central Rys., Chicago, Ill. SYMPOSIUM-"THE SURGICAL ORGANIZATION OF THE RAILWAY SERVICE."

A. "The Advancement of the Surgical Service of Our Railway Systems," R. Harvey Reed, M. D., surgeon Union Pacific Ry., Rock Springs, Wyo.

B. "Is the Management of the Surgical Service Through a Chief Surgeon an Improvement Over Its Management by an Unprofessional Official of the Company S. L. McCurdy, M. D., surgeon Pennsylvania Ry., Pittsburg, Pa.

Discussion opened by George Chaffee, M. D., surgeon Long Island Railway, Brooklyn, N. Y.

C. The Advantages and Disadvantages of the Volunteer Relief System," W. W. Grant, M. D., consulting surgeon U. P. Ry. and surgeon C., R. I. & P. Ry., Denver, Colo.

D. "The Advantages and Disadvantages of Hospital System."

E. "Suggestions for the Best Modern Practical Plan for the Organization of the Surgical Service of Our Railway Systems."

Committee of Arrangements, Kansas City, Mo.: J. W. Perkins, M. D., chairman; Samuel Avres, M. D., C. Lester Hall, M. D., B. E. Fryer, M. D., B. C. Hyde, M. D.

Hospital Notes.

STEEL COMPANY WILL BUILD MANY HOSPITALS.

Steel workers of South Chicago and Joliet are aroused as the result of the announced attention of the American Steel & Wire Company to establish emergency hospitais in all of its twenty-two plants. Back of the seeming philanthropy of the corporation they pretend to see a scheme

for preventing the awarding of damage suits against the company. They say that their experiences with hospitals managed by large corporations have made them wary of such enterprises.

At present the Illinois Steel Company has emergency hospitals at both Joliet and South Chicago. The steel workers declare that at these hospitals men injured in the company's works are virtually held as prisoners. Their relatives are not allowed to see them and in some instances men have died at the hospitals before their friends were aware they were injured.

It is declared that the purpose of the company is to prevent the inauguration of damage suits against it and as the hospitals are under their supervision it is impossible for injured employes to recover damages. The relatives. of those who die are at a similar disadvantage.

There is little probability that any opposition to the plans of the American Steel & Wire Company will manifest itself. Still there is considerable feeling among the men. Those employed by the Federal Steel Company are as much affected as those of the wire company. Both are component parts of the United States Steel Corporation, and it is believed that the plans of the American Steel & Wire Company will be adopted by the other affiliated corporations.

The plans for the buildings, which will be as nearly uniform as conditions will permit, are being prepared by a Philadelphia architect, and the total cost to the company of buildings and equipment will not fall far short of $300,000.

The determination of the company to establish a hospital at each one of its plants was arrived at after a year's experiment with a temporary emergency hospital, erected for the company in Allentown, Pa.

Little was said of the new movement at the time the Allentown hospital was put into service, and few persons outside of the officials were aware of the company's intentions. It did not require a full year to prove the value of such an institution, either in point of bodily comfort to the unfortunate iron workers who were forced to enter it for treatment, or in point of ultimate expense to the corporation. For several months the company has been shaping its plans for hospitals at all its plants, and it is calculated that within the next six months all will be ready to receive patients.

Each hospital will be of plain brick construction, two stories in height, with baths, sitting-rooms, library, dining-rooms and sleeping apartments for the nurses; will have quarters for six beds, that number being figured as the maximum of cases that may need attention at the same time.

A corps of six nurses and two druggists and thorough ambulance service will be requisite for each hospital in addition to the resident physician.

Railway Miscellany.

What Railroads Are Doing for the Country.

The value of railroad improvements to cities and towns is beyond calculation. While primarily made by the railroad companies for their own benefit, there is a resulting advantage to the communities wherein they are made which is seldom or never taken account of. At the present time enormous expenditures are in progress in all the largest cities, wherein lasting advantages will be conferred, not only in traffic facilities, but in many indirect ways.

The policy of the railroad management of the country is broad, unselfish, far-reaching. Instead of following a policy of minimum expenditure, which is the policy in most individual and small corporate enterprises, the railroads methodically pursue a policy of a maximum expenditure with the view of elevating the efficiency and thoroughness of railroad service to the highest degree. These outlays are made with a view of future needs rather than existing needs. When an improvement is undertaken the needs and possibilities of ten, twenty or thirty years ahead are regarded, and enter into the calculations.

The entire business interests of every city and town in the United States served by railroads are benefited to a degree and in a manner which private or corporate enterprise outside of railroads could not confer.

When the expenditures contemplated by the Pennsylvania Railroad in New York City are completed it will place that city in a better position to maintain its commercial supremacy. Every business interest of that metropolis will be benefited. When the millions now set aside for Philadelphia are transformed into improvements projected and under way, the result will be that Philadelphia will find herself pushed up several notches in the commercial scale, as well as placed in stronger commercial relations to other Atlantic shed cities. The same is true of other cities by the

score.

The showering of these benefits draws forth no favorable comment, but the shower continues and will continue. The railroads are and will, as they must, continue to be the greatest factor in the material well-being of the country.

One of these benefits will be briefly pointed out. In times past panics have occurred, sweeping ones at intervals of twenty years, lesser ones of a purely financial character, more frequently. The political economist has not yet arisen who has clearly elucidated all the hidden agencies which have resulted in these disorders which swept tens of thousands into bankruptcy and led other tens of thousands to its brink. The great preventing cause to these recurring panics, greater and lesser, is or will be the force which railroad transportation, on its scale of magnitude, will generate, has generated, is generating. This force will not manifest itself to the reader's mind at once, but it is there. It is the force of equilibrium which results from the stimulation of energies of all kinds.

This mighty force is self-protecting. It is our national resource. It gives occupation for the millions, markets at every crossroads, it creates activities and leads to the expansion of facilities for wealth production. It creates reserves, both in merchandise and money. It builds up enormous volumes of capital. It lessens destructive competition and enlarges legitimate competition. It multiplies opportunities and gives each worker more elbow room.

It is this process which has been going on for years. It makes collapse less probable, overproductoin more difficult. It makes capital more abundant, more confident, earnings more secure, individuals more independent.

For these reasons the possibility of a panic is made more remote. more difficult. Productive and distributive agencies have been placed under greater control. Railroads have been and are and will long continue to be the greatest factor in the prevention of those disturbances which terminate in industrial panics. They gather where plenty smiles and

distribute where want grins. They make industries profitable thousands of miles from where they had their birth. They encourage industry and work toward a lower level of the cost of living. They assist the masses to utilize their ener gies and capacities, and thus harmonize all the great agencies which are working toward the well-being of the nation and the people.-International Railway Journal.

The speed performances of the new 20-hour New YorkChicago trains have aroused great interest throughout the country, more especially in the daily press. Particular notice is taken of the speed attained and the continued regularity of service rather than of the mechanical means used to accomplish these ends, which goes to show that the people as a whole are more interested in results than in methods. Some discussion has arisen as to the safety of these trains. It has been assumed by some that in respect of the time and distance required for stopping, the new trains are especially hazardous on account of the speed, which is takeu as being higher than that previously reached in regular practice. That this should be the case is, perhaps, a natural assumption for the layman to make, but railway men know that it is not necessarily the fast, long-distance train, that really runs the fastest. In fact, it is seldom that express trains cover single miles at a quicker pace than that at which many locals are obliged to run between stations in order to make fair average time over the division. The record-breaking bursts frequently announced are almost invariably the results of being behind the schedule, and certainly the local trains are most subject to delay. As a consequence, it is often necessary to run between stops at the maximum speed of the engine. A train which runs 100 miles without stop may do the distance in two hours, at 50 miles per hour, and if the division is level and no slowdowns are required, it may keep near to that average speed all the way. A local which makes 12 stops in the distance and loses on the average five minutes each time, a fair assumption, in stopping, standing and starting, will lose in all an hour on the division. If, then, the local's schedule calls for a time of three hours, it will be obliged to run as fast as the express, or faster, for short distances. All this is well known to railroad men, but, as it is the uninformed public that does most of the riding, it may not come amiss to bring out the point. As to the safety of the express trains, it must be remembered that in such service is placed the best of equip ment, that they are given the most attention and inspection, and that from start to stop every employe on the division is surcharged with vigilance for the safety of the "Limited." It is a marked train, and for that reason, if for no other, safer than many locals, universally good as the service may be.

The Wabash is reported to have put into operation the novel plan of giving invalid employes a trip to California with a view to restoring them to health. A party of 40 invalids who were formerly inmates of the company's hospital at Peru, Ind., have started for southern California in charge of three trained nurses. They are traveling in special cars, equipped so that they are virtually traveling hospitals. The railroad company is bearing the entire expense, and if the plan results in making the employes able to return to their duties the management will consider the money well expended.

A man in Indian Territory has sued the Missouri Kansas & Texas for $6,000, charging that while he was asleep another passenger inflicted a severe knife wound on him. This, he thinks, proves negligence on the part of the company in not affording proper protection to its passengers against drunken persons.

The statement that the Louisville & Nashville road is unique in having a woman city ticket agent brings the discovery by some of the dailies that the Grand Trunk, Canadian Pacific, New York Central and Ann Arbor roads are among those which employ women in similar capacities.

VOL. IX.

FOUR CASES, REPRESENTING PERIODS IN
THE EVOLUTION OF THE TREATMENT
OF HIP-JOINT DISLOCATION.*

BY S. S. THORN, M. D., OF TOLEDO, OHIO, EX-PRESIDENT I. A. R. S., CHIEF SURGEON T., ST. L. AND W.

All dislocations of the femur are either regular or irregular, depending for this classification upon the fact of the non-rupture or rupture of the ilio-femoral or Yligament of Bigelow. The existence of rupture is indicated by the varying positions of the head in manipulation or other efforts at reduction, whereas, when the Yligament is intact the head is usually found in one of three or four common positions, remaining in them or reduced from them.

Both of these, the regular and the irregular dislocations, may exist under four forms. According to Hamilton we have:

I. Upward and backward upon the dorsum of the ilium.

II. Upward and backward into the ischiatic notch.
Upward and forward upon the pubes.
Downward and forward into the obturator fora-

III. IV. men.

In the cases reported below I shall assume that the diagnosis has been made in each, and that all are dorsal dislocations.

Soon after beginning practice I was invited by Dr. W. to see with him a case of injury at the hip-joint. Examination disclosed dislocation upon the dorsum. Reduction was attempted without anesthetics. The surgeon placing his foot against the perineum, for counter extension, and extension was made by traction upon the thigh just above the knee. Failing in this, the bed was placed in the middle of the room between an open door and window, a broad band was carried under the body, over the perineum and upwards over the abdomen, chest and shoulder of the same side; this was secured by a cord to a stick across the open window outside. All of this for counter extension, while extension was made by carrying a band about the thigh in the form of a clove hitch; this extended and passed around a piece of timber across and outside the door opening. Traction was then made by a twist or Spanish windlass, great care being had not to injure the muscles. Reduction was accomplished with the usual "pop."

2. I saw the patient some hours after the accident, which was a fall from a height, he landing upon his

*Read at fifteenth annual meeting, I. A. R. S., St. Louis, April 30 to May 2, 1902.

No 5

flexed knee. Force was oblique to long axis of leg. Under anesthetics Reed's method by manipulation, flexion and rotation was resorted to with apparent success. However, the usual sound of the head's entrance into the socket was not well marked. Flexion of thigh upon pelvis to test and settle fact of reduction was tried, but the slight motion again projected the head upon the dorsum. This was more than once repeated with the same results. We were therefore led to believe that the rim of the acetabulum had been knocked off. For further test the Jarvis adjustor was used. Extension was made parallel with the long axis of the thigh, but oblique to that of the body. After pretty full tension had been secured the limb was rotated and the head slowly moved to the socket. Extension was maintained until the next morning, with the hope that the soft parts would contract so that the head would remain in position. After twenty hours the instrument was loosened up, and with it the head slipped to the dorsum. The diagnosis of dorsal dislocation with fracture of rim of acetabulum was confirmed at post-mortem the third day after. Death from rupture of liver.

3. Boy, 18 years old, was thrown by a bull. On rescue was found badly crippled by dislocation of head upon dorsum. I did not see the patient for some days after accident. Reduction by Reed's method attempted, but without success. Extension and counter extension in long axis of body not yielding better results, the boy was placed on his back upon the floor, the legs flexed upon the thigh and the thigh upon the pelvis. Then, taking a position astride the limb, my face toward the boy, I clinched my hands under the leg over and above the heads of the gastrocnemius, then settling down upon his leg and using it as a lever and my hands as power, I lifted strongly upon the leg, continuing this for some time, then using the leg as a lever rotated the head into the socket, but not without considerable force being used.

An adult train hand, in making a coupling while. stooping over the drawbars was struck from behind and so held as to force the head of the femur upon the left dorsum. ceivable methods and success not following, I was wired After five hours of earnest effort by all conto go to the man. He was ordered to Toledo, and on the next night, nearly 48 hours after the accident, he was placed upon the operating table at St. Vincent's Hospital. The table stood 34 inches high. While the patient was being anesthetized, Dr. M., who came with him, gave a detailed account of the efforts made by himself and associates. All known methods had been fully

tried. As a last resort I had the patient, under profound anesthesia, placed face downward on the table, his body drawn well down to the end of the table, so that his legs hung easily over; they were consequently flexed upon the pelvis. The foot of the table had been so placed as to make its height 40 inches above the floor. After resting a short time in this position a thorough examination of the hip showed the head well upon the dorsum and all parts rigid. I now placed my left hand over the head of the bone, swung the limb a few times from right to left, and under this motion felt the head move. Now flexing the leg upon the thigh, my left hand placed over the heads of the gastrocnemius and handling the foot with the right, I gently moved it a few times, and with about two pounds pressure, with left hand, the head of the bone dropped into its socket. The usual sound being given out. Time occupied was about one and one-half minutes. The success was speedily, easily and safely brought about, and was a surprise to all present. I was not so much surprised by the result as by the ease and rapidity of success.

A little study of the joint and its ligaments will serve to make clear the mechanism of the process. The ilio

femoral or Y-ligament of Bigelow is an accessory band of fibres springing from the anterior inferior spine of the ilium, extending obliquely down or across the front of the joint. It is intimately connected with the capsular ligament, serving to strengthen it in this situation, and is attached below to the anterior intertrochanteric line, bifurcated to resemble a Y. The drawing here shows the form of the strong band, but lies as we see it, as it is found in dorsal dislocations, folded upon itself and twisted about the neck. A careful study of it will show

how naturally and easily it will help in our efforts at unfolding and reduction. unfolding and reduction. This is done by its holding the head and neck in position and by preventing the head traveling about and around the socket, as is the case in the irregular dislocations at this joint. It will also explain the great difficulty attending uninstructed and illy directed attempts. In these it serves to hinder rather than to help. Reed's methods (and these cover Gunn's and Bigelow's) of reduction, depend for their casy accomplishment upon the knowledge of the function of this strong band. Since this case I have succeeded in reducing five other cases of dorsal dislocation by this same process.

Symptoms of dislocation, to differentiate as between dislocation, fracture of the neck, or with contusion about the joint-these being about the only conditions met with causing any doubts:

Symptoms in Common, Pain, Extensive, Ecchymoses, Loss of Function, Apparent Shortening, History, Flexion of Leg upon Thigh and Thigh upon Pelvis.

DISCUSSION.

Dr. Albert J. Best of Centralia, Kansas, reported a case of dislocation of the hip-joint, which he reduced successfully by adopting a method similar to the one employed by Dr. Thorn in his third case.

Dr. H. C. Fairbrother of East St. Louis, Ill. We are indebted to Dr. Thorn for a new method of reducing dislocation of the hip-joint. I am greatly interested in it, more particularly from the standpoint of its effectiveness, and it seems to me to be a great improvement over any of the methods of reduction laid down in our textbooks. There is no dislocation which has given me so much trouble as that of the hip. My early cases of dislocation of the hip-joint were not among the Indians, like those of Dr. Thorn, but they date back thirty years. I believe, after hearing the paper, that this dislocation will give me less trouble than it has heretofore.

Dr. Thorn (closing): If I understood Dr. Best correctly, he described a method similar to the one I carried out in my third case. My third case was a distinct advance upon the second, and the second was a notable improvement upon the first. This is the fourth one, and you can readily see it was an evolution in the management of hip-joint dislocations upon the dorsum, etc.

Never forget that the surgeon who neglects to suture a divided nerve or tendon commits the same mistake as he Use an ordinary who neglects to reduce a fracture. sewing needle, with a dull point for nerves.--Fenwick.

Fracture at the elbow is very frequent in childhood; and treat it as we may; by flexion or extension, limitation of motion almost invariably follows-to quite as invariably recover after a long period of time.-Manley.