liable to develop in the region of the valves because the blood flows less rapidly at these points. Thus microorganisms find lodgment more easily, and by the deposit of corpuscles we get thrombi, which become infected, broken down, and the particles are carried along the veins as emboli, where they may again be stopped by other valves, and the same phenomena reproduced. These thrombi may also cause distension of the veins, terminating either by recovery, by periphlebitis, phleboliths or by general pyemia.

On October 7, 1901, while repairing a barb wire fence in South Dakota, Mr. C― received a lacerated wound in the palm of his left hand. He gave almost no attention to the injured member for the reason that he suffered little or no inconvenience. After about a month almost all the tenderness disappeared, and the wound was apparently closed. A little later he removed a thin scale from the scar, and a few drops of pus was discovered. He then consulted a local physician, who gave him an ointment to apply; this he used for another month. He returned to Beloit and December 14, 1901, Mr. Cfirst came to me for treatment. At this time there was still pus in the primary wound. There were also two or three small, hard nodules about half the size of a lima bean on the back of the hand. The nodules I painted with tincture of iodin and I cleaned and drained the wound, then dressed the whole hand with a hot, moist bichlorid dressing. This was repeated every day for a week (all this time the patient insisted on keeping at work); one night I failed to show up at the office and he went to another physician.

January 30, 1902, he again returned to me for treatment. By this time the infection had spread beyond the elbow on both the flexor and extensor surfaces, with no glandular enlargement in the elbow or axilla. I informed him that his condition was serious and that he had better enter the hospital for treatment. On entrance his temperature was 97 8-10 degrees; pulse, 58; urine, sp. g., 1018-no al bumen, no sugar; slight edema of the arm; general appearance good. If you will examine the accompanying photographs, which were taken at Dr. Bouffleur's suggestion, when he saw the patient a few days after his admission, you will recognize these so-called circumscribed nodules focated at the valves of the veins, in some locations the intervalvular portion apparently escaping the active inflammation.

Treatment: The patient was put to bed, the arm elevated and enveloped in warm, moist antiseptic dressing, covered with rubber tissue and cotton, and in addition the application of Ung. Credé to those nodules which were not broken down. The fluctuating nodules were opened and drained. This dressing was repeated every four hours. He was also given a general tonic, nutritious diet, and strict attention was paid to the eliminative

February 19 (nineteen days after his admission to the hospital) the patient returned home.

No more new nodules developed and in one week's time all the abscesses were closed and the patient went without a dressing.

During his stay in the hospital his temperature was never above 101 degrees, and that only for a few hours. This was due to an acute rhinitis and bronchitis contracted the first night at the hospital.

Vanderveer of Albany, N. Y., reports four cases of suppurative phlebitis of the left saphenous; two following oophorectomy, one appendicitis and one angioma of the liver. Strauch of Moscow reports three cases of suppurative phlebitis of the left saphenous; two following oöphorectomy and one hysterectomy.

SURGICAL SERVICE FOR THE NEW YORK CENTRAL.

Recent heavy verdicts against the New York Central Railroad in damage suits have set the officials of that road at work to devise some method of protecting itself. With this end in view it has decided to employ sixty surgeons, whose duty it will be to go at once to the scene of an accident and give aid to the injured. Each physician will be assigned to a specified section of the road.

It is hoped in this way that many lives will be saved, and very often crushed limbs, being propertly attended to within a short time of their being injured, may not have to be amputated.

While the burden of the expense will be large the company thinks it will pay, for not only will they lessen the number of seriously injured, and, therefore, the amount of damage which may be claimed, but they will also have their own surgeons as witnesses, as a check on those who may attempt to exaggerate the nature of their injuries. It has also been ordered that a full set of instruments be carried on every train, so that if there be a surgeon on board at the time of an accident he will have all the facilities for giving relief that he would have were he called in a professional capacity.

Train hands are also receiving instructions in First Aid to the injured.

Traumatic Scarlatina.-F. Ocaranza (Cronica Médica Mexicana, November 1, 1902) gives the history of a patient whom he believes to have been affected with trau

matic scarlatina; a condition first described by Paget and May in 1864, and since disputed by the various schools of medicine, foremost among which may be mentioned the Russian, which has made it the subject of numerous arguments, pro and con. In the case reported, the patient suffered slight traumatism of the scalp resulting later in abscess formation, accompanied by an eruption upon the skin, which extended from the neck to the thorax, arms and abdomen, and subsequently to the lower extremities. The eruption disappeared on pressure, and coincident. with it fever and angina set in. Furfuraceous desquamation commenced within eight days, and this marked the beginning of improvement in the abscess, which had, up to

this time, remained stationary.

Do not hurry separation of sloughs in frost-bite gangrene.-Fenwick.

THE

Railway Surgeon

A Monthly Journal of Traumatic Surgery

MONADNOCK BLOCK, CHICAGO, ILL.

The magnitude of this unscrupulous method at the present day can be judged of from the facts presented elsewhere in this issue. The New York Health DepartThe New York Health Department purchased in open market 373 lots of what purported to be a certain drug, from as many different stores. Out of this number 58 only were found pure! Surely this practice needs some drastic measures for its suppression. Just what these need to be is a matter for future consideration. In the meantime the New York College of Pharmacy has passed the following resolutions:

"Whereas, The substitution of one article when another is called for, or of an article of one brand when that of another is ordered, involves an act of deception and an abuse of the confidence of physician or patient, and an act of injustice toward the manufacturer of the article so specified; and,

"Whereas, The general commission of such acts is

"Resolved, That the College of Pharmacy of the City of New York publicly condemns all acts of substitution, whether in prescription work or ordinary trade; that it declares such practices to be violations of just dealing, opposed to the principles of professional ethics and subversive of good morals; and it is further.

"Resolved, That we exert our utmost influence, both as individuals and as an institution, to discourage such practices and to promote professional and commercial confidence."

THE PATHOLOGIC ANATOMY OF CEREBRAL CONCUSSION.

In the last number of the Journal of the Association of Military Surgeons,* M. Nimier, who is a professor at the celebrated army medical school at Val-de-Grace, contributes an interesting note on the pathologic anatomy of cerebral concussion.

A soldier committed suicide by shooting himself with a Lebel rifle. The point of entrance was in the center of the supra-hyoid region, and the bullet escaped just to the right of the median line in the vertex. The point of exit in the scalp was small, but slightly lacerated, and contained a small amount of brain matter. The skull was severely fractured, presenting a hole from which radiated six fissures, two antero-posterior, two transverse, and the remaining two obliquely back and outward. All of these except the posterior connected with a circular horizontal fissure at the level of the temporal fossæ, almost completely severing the vault of the cranium from the base. In addition the base exhibited the point of entrance, very nearly corresponding to the sella turcica, and from this four fissures radiated, one being lost to the right of the foramen magnum, the others connecting with the three anterior fissures of the vault. This shows the bursting effect of intra-cranial missiles, and, as the author remarks, shows the action of the projectile was not confined to the two points encountered in its course.

As regards the cranial contents, the missile destroyed the optic chiasma, as well as the anterior part of the right optic tract. It perforated the corpus callosum a little to the right of the center, and grooved the inner surface of the right hemisphere as far as the anterior aspect of the paracentral lobule. The subarachnoid space was distended with blood, as was the lateral ventricles and the fourth ventricle.

Fragments of tissue from the optic tract, the frontal and occipital lobes, the pons, medulla and cerebellum were removed for histologic examination. This revealed the interesting fact that there was a total absence of any anatomic lesion.

"Therefore," says the author, "a bullet endowed with powerful energy has passed through the brain, causing

*January, 1903, p. 24.

to the cars. One manufacturing concern has submitted to us material called 'Transite,' in honor of rapid transit. It is made of hard sheets of asbestos, which will be placed in layers along the extreme bottom of the cars. The wires, all insulated, will be placed in asbestos pipes, and these again will be placed in asbestos ducts. Above these will be another flooring of 'transite.' On the floors of the cars proper will be placed a new material like matting, made of asbestos.

"As to the superstructure, we have not yet decided, but if we can be convinced that there is any wood that is fireproof we will give it careful consideration. Until we settle this fireproofing question I do not think the company should be criticised."-Ex.

TREATMENT FOR ELECTRIC SHOCK.

The Electrical World and Engineer is the authority for the statement that accidental electric shocks seldom result in death unless the victim is left unaided too long, or efforts at resuscitation are stopped too early, as in the majority of instances the shock is sufficient only to suspend animation temporarily, owing to the momentary and imperfect contact of the conductors, and also on account of the resistance of the body submitted to the action of the current. The rules given to be observed and promptly executed with care and deliberation are as follows:

"Rule 1-Remove the body at once from the circuit by breaking contact with the conductors. This may be accomplished by using a dry stick of wood, which is a nonconductor, to roll the body over to one side, or to brush aside a wire, if that is conveying the current. When a stick is not at hand, any dry piece of clothing may be utilized to protect the hand in seizing the body of the victim, unless rubber gloves are convenient. If the body is in contact with the earth, the coat-tails of the victim, or any loose or detached piece of clothing, may be seized with impunity to draw it away from the conductor. When this has been accomplished observe rule 2. The object to be attained is to make the subject breathe, and if this can be accomplished and continued, he can be saved.

"Rule 2-Turn the body upon the back, loosen the collar and clothing about the neck, roll up a coat and place it under the shoulders, so as to throw the head back, and then make efforts to establish respiration (in other words, make him breathe), just as would be done in case of drowning. To accomplish this, kneel at the subject's head, facing him, and seizing both arms draw them forcibly to their full length over the head, so as to bring them almost together above it, and hold them there for two or three seconds only. (This is to expand the chest and favor the entrance of air into the lungs.) Then carry the arms down to the sides and front of the chest, firmly compressing the chest walls, and expel the air from the lungs. Repeat this maneuver at least sixteen times per minute. These efforts should be continued unremittingly for at least an hour, or until natural respiration is established.

"Rule 3-At the same time that this is being done someone should grasp the tongue of the subject with a handkerchief or piece of cloth to prevent it slipping, and draw it forcibly out when the arms are extended above the head and allow it to recede when the chest is compressed. This maneuver should likewise be repeated at least sixteen

times per minute. This serves the double purpose of freeing the throat so as to permit air to enter the lungs, and also by exciting a reflex irritation from forcible contact of the under part of the tongue against the lower teeth, frequently stimulates an involuntary effort at respiration. To secure the tongue if the teeth are clenched, force the jaws apart with a stick, a piece of wood or the handle of a pocket-knift.

"Rule 4-The dashing of cold water into the face will sometimes produce sometimes produce a gasp and start breathing, which should then be continued as directed above. If this is not successful the spine may be rubbed vigorously with a piece of ice. Alternate applications of heat and cold over the region of the heart will accomplish the same object in some instances. It is both useless and unwise to attempt to administer stimulants to the victim in the usual manner, by pouring it down his throat."

ACCIDENTS TO ORDER.

A man who is ready and willing to risk having his bones broken at so much per bone was arrested at the request of the Philadelphia police, where he is under indictment for conspiracy.

According to the stories told by H. C. Silcox, an inspector of the Philadelphia Rapid Transit Company, Doran was one of a gang of eight, who made their living by falling off street cars and then claiming damages from the company. Doran was a contortionist and could let a thirty-mile-an-hour car run over him and escape with $5 or $10 worth of damages. Doran was indicted in May, 1901, and had been missing until two central office detectives ran across him last night.

The police claim to have run down all the members of this gang now and that the other men have confessed the whole business. The inspector went over the records last night and described a number of cases in which the company had settled with members of the gang in accident.

cases.

One of the first cases they say Doran was in was on April 13, 1900. He and Charles Ridner, who, according to the police, has just been released from a year's term of imprisonment on a charge of conspiracy in connection with these "accidents," got on a Philadelphia trolley car. Doran fell off purposely. He pretended to be badly hurt, gave Ridner's name and was removed to Ridner's home. Then he went to bed and the adjuster visited him. He settled for $60. This case is typical of all the others as told by the railroad men.

Another record given was that on October 26, 1900, Doran made his wife, Margaret, fall off a car while he had two friends watching at the spot to be witnesses. She disiocated both ankles and broke an arm, but got $35.

The inspector and adjuster say the gang was clever in working the game at various parts of the city, so as not to have the same adjuster too often, but they had to have one man three times. This served to run them down.

Silcox says that at least five gangs have been at work swindling the trolley companies in this game, and he claims that in the last fourteen months thirty-four persons have been arrested and convicted in connection with the swindle.-Exchange.