THE ANNUAL MEETING.

At a recent meeting of the executive board arrangements for the coming meeting were practically completed. The sessions will be held in the Deutscher Haus, which corresponds somewhat to Harmonie Hall in Detroit, in which our 1900 meeting was held. There is ample space for the exhibits and for committee rooms, etc. Dr. J. H. Ford, chief surgeon of the Big Four, has been appointed chairman of the committee of arrangements, which is good evidence that all details will be carefully looked after.

The committee on transportation report that from present indications the same courtesies will be extended

as in former years. A fuller report will be made later. The exact date of the meeting will be announced in the next issue. In the meantime members should be at work on their contributions.

A REMARKABLE CASE OF TRAUMATISM,

Varnier of Paris reports a remarkable case,* showing that sometimes the most severe violence will have no effect on the course of pregnancy. A young woman, 18 years of age, on May 24 threw herself out of a second story window into the street. When admitted to the hospital she was comatose, there was hemorrhage from the mouth, nose and left ear, with internal strabismus of the left eye. A diagnosis of basal fracture was made. At the end of eight days the patient recovered consciousness, and was discharged in a month. Normal labor at term occurred on August 14. The strabismus still persisted with complete deafness on the left and a little limping.

Trephining Skull for Headache. The patient had suffered with headache since her earliest recollection. The skull showed quite a decided depression at one point where a pronounced swelling appeared whenever she lay down. As all other means of cure had been tried in vain an operation was resorted to and the depressed bone removed. After the operation all of the physical signs and symptoms of disease disappeared and in a short time the patient could again take up her housework. A year and a half later the girl was still perfectly well. The author's idea is that the depression must have resulted from some injury, although there was no history of anything of the kind. At the same time he considers the swelling to be due to the escape of lymph into the diseased area. He has gathered from the literature twelve similar cases, all of which were cured by removing the depressed bone. In most instances it seems to him best to close the bone opening again with the button which has been removed. The symptoms in such cases are always referable to the depressed area.-Interstate Med. Jour.

A Philadelphia firm has received an order from the Japanese government for several X-ray machines which are to be used for a novel purpose.

The firm some time ago sold to a representative of the Mikado an X-ray machine which, the Japanese explained, was to be used in the governmental mints in Japan for the detection of dishonest employes who stole gold coins by swallowing them.

The machine was used to examine suspects as they left the mint daily, and, of course, it revealed the presence of any coins "in their midst."

The test was so satisfactory that the Mikado ordered several more machines, hoping to prevent this form of theft. St. Louis Med. Rev.

Never forget in fistula in ano to eliminate foreign body, ulceration, stricture and malignant disease of the rectum.-Fenwick.

*Annales de Gynecologie, Tome LIV.

First Aid and Emergency.

(Conducted by CHARLES R. DICKSON, M. D., Toronto, Can.)

FIRST AID TO ACCIDENTS. By Charles R. Dickson, M. D. Chicago: F. H. Revell Company.

The International Association of Railway Surgeons has done a good thing for the railway service in having. this little manual of 128 pages prepared by Dr. Dickson. The preface says the manual "is intended to be a basis of instruction as well as a means of refernec, and should be accompanied by systematic lectures by a qualified medical man, followed by demonstrations, without which knowledge, gained merely by reading, would be very superficial and of little practical value." Nevertheless, non-professional readers can gain much instruction from reading the volume, particularly the chapters on "Injuries" and on "Carrying the Disabled and Preparations to Receive Them." The illustrations on the latter topic help very much to understand how to handle those who are taken from wrecks or who have otherwise suffered injuries. The Railway Age.

FIRST AID MANUALS.

The great attention now being given to the subject of first aid to the injured is bringing a harvest of first-aid manuals, new ones being launched by the publishing houses with great frequency. And, as a matter of course, these manuals are of all sorts and kinds, from a very cheap pamphlet to a large erudite volume.

The fear has been expressed that in some instances the matter is overdone, and that the authors' efforts are too much on the order, “every man his own doctor." In some of these volumes treatment is suggested for every sort of ailment, from a stubbed toe to a deep-seated disorder. An attempt is made to teach to a layman the science of surgery and medicine in all its branches, in one volume. And it may be well said that the reader is confused, and in the attempt to carry out the instructions goes astray.

First aid by a layman means to render an injured person intelligent assistance until the arrival of a medical attendant, and assist in doing a few essential things quickly, and there his office ends. All the first-aid manuals ever printed, if taken together, could not transform a layman into a surgeon, nor teach him how to treat disease. Further than this, a butcher's cleaver is a most formidable weapon in the hands of a child. A little knowledge of anatomy and physiology, while useful, is not essential in first aid. Many manuals make a poor attempt to cram the lay mind with the names and functions of the whole human system, to his great bewilderment. Any intelligent person can gain a good knowledge of this subject from an elementary text-book, such as is used in common schools, and in such works they are in plain, simple language. But better than all is a few lessons from a good physician, who will point out the course of the main arteries and the principal point of the bony structure and system. This, aided by the study of the student's own anatomy, or that of a friend, will give him the best sort of a practical knowledge of the subject. Among the writer's acquaintance is one who has han

dled successfully hundreds of injured persons, who acknowledges that he does not know the name of a single bone or muscle; his only knowledge of the location. of arteries, nerves, veins, etc., is that attained from actually handling them. The same remarks may well apply to other lines of knowledge.

Probably the best manuals are those which get at the point, tell in plain language and few words the simBetter than plest thing to do without giving any reason.

all are those manuals which give instruction by picture. As an example, very many injuries are accompanied by bleeding. In ninety-nine cases in a hundred pressure rightly applied will stop it. One has to remember only a few simple points to promptly render efficient aid. The proper points for this can be quickly grasped from studying a picture, especially if the picture is colored to show

the course of the arteries and veins. Or a few minutes' instruction by a physician will give the needed information. In absence of either of these, a little practice on one's own self will enable him to find the throbbing arteries. When the bleeding has been stopped, the surgeon summoned and the wound covered, the patient placed in a comfortable position, it is time to stop.-Red Cross Notes.

The authorities of the Jefferson Medical College (Philadelphia) have offered to give a free course of training in first aid to the employes of the various roads entering the city.

Personal.

Dr. F. W. Powers has been appointed surgeon of the C. G. W. at Waterloo, Ia.

Dr. W. B. Haughey of Ann Arbor, Mich., has been appointed local surgeon for the Michigan Central.

Dr. W. F. Grinstead of Cairo, Ill., left on February I for a trip of four months to Europe and the Holy Land. Dr. G. K. Meynen of Jamaica has been appointed chief surgeon of the Long Island Railway Company, vice Dr. J. F. Valentine, deceased.

Dr. M. Gardner of San Francisco, chief surgeon of the Southern Pacific, has been appointed a member of the California State Board of Health.

L. L. Syman of Springfield, Ohio, has recently been appointed chief surgeon of the Detroit Southern Railroad, for both the northern and southern divisions.

Dr. Wm. Jepson is first vice-president, Dr. J. N. Warren, chairman of the committee of arrangements, Dr. H. C. Eschbach, chairman of the section on practice and Dr. G. G. Cottam, chairman of the section on surgery at the forthcoming meeting of the Iowa State Medical Society.

Never put atropin into an eye:

1. Without testing tension.

2. Without examining for locomotor ataxia (for ataxic cases walk by sight).

3. Without due care as to strength of solution in old people. (N. B. Be cautious about exhibiting atropin, ergot and colchicum in old people).-Fenwick.

A case of unusual interest to the profession is that brought in the Elkhart Circuit Court by Shelley against Dr. G. W. Spohn, of Elkhart, for burns caused by the X-ray. The defendant procured a change of venue to the LaGrange Circuit Court, in which court the case was tried early in December last.

Dr. Spohn is a specialist and has been using the X-ray in treating his patients for some time. The plaintiff came to Dr. Spohn, last spring, suffering with a growth on the under left side of his tongue. He diagnosed the growth as cancer and told the patient the only thing he could do for him was to treat him with the X-ray. The patient consented; the doctor told him of the uncertainties of a burn and then gave him about a dozen treatments, one each day for about two weeks. After the last treatment Dr. Spohn noticed a very slight dermatitis beginning on Mr. Shelley's face. He gave him a lotion to put on his face; no more X-ray treatments were given him, and the patient, after visiting Dr. Spohn a few times, left the city, he claimed, for treatment of his burns. He later brought his action for malpractice, claiming $10,000 damages and alleging that the burns were due to the doctor's negligence in not providing a covering for the face to protect it from the action of the rays. He further alleged that he was directed to use his hand to hold down the lower jaw during the exposures; that there was produced a severe burn on the hand, which has permanently crippled it; and that each exposure lasted an excessively long time. The doctor denied the complaint generally and set up contributory negligence on the part of the plaintiff.

Plaintiff appeared in court, his face showing no perceptible signs of having been burned, while his hand was badly distorted, a sore on the back, close up to the knuckle of the middle finger, on healing, having drawn up that finger and generally distorted the hand. The serious part of the case was therefore to explain away the injury to the hand. There was not much contention over the burned face. The doctor did not deny that the face had been burned. He contended that there was no way of telling what strength of ray would burn a particular patient, for a ray that would produce a dermatitis in the tissues of one person might not affect another at all. He said he used a medium vacuum tube and provided a suitable covering for those parts of the face which he wished to protect. At first this covering was a lead disc for two or three exposures, and then lead foil was used with other materials during the remainder of the treatments. These statements were all corroborated by the doctor's assistant, who attended each treatment, and who, during the most of the time, held the coverings on the face of the patient. The plaintiff testified that each treatment lasted thirty minutes, while the defendant and his assistant both testified that the

treatments lasted from three to seven minutes. The questions of length of exposure and failure to use a proper covering were, therefore, one of fact entirely, with the statement of the plaintiff unsupported on the one side, and the statement of the defendant supported by that of his assistant on the other, and approved as good practice by his experts. The plaintiff attempted to strengthen this part of his case by introducing photographs taken of himself showing the condition of his face from time to time. They showed the face to be greatly swollen at first, so much so that he said that he could hardly see. But that fact counted for nothing when once the use of a proper covering was proved.

Plaintiff further contended that his eye was injured so that the vision was considerably affected. Defendant's experts examined the eye and found nothing unusual. So that charge failed. There was nothing left then but to explain the distorted hand.

The plaintiff alone testified as to the use of his hand as alleged. Dr. Spohn, corroborated by his assistant, said that the plaintiff continually used his hand to wipe the saliva from his chin, against explicit directions to keep the hand down; and that in doing so the covering would be knocked off the face, necessitating the cutting off of the current. The plaintiff was suffering considerably from cancer and had little vitality during the treatments, and his restlessness, together with his persistence in wiping off his chin, which, of course, was underneath the covering, brought his hand up to or near the path of the rays, and it would have been acted upon by the rays had there been no covering.

Defendant's experts took the view that the X-ray, when it burns at all, produces a dermatitis upon the tissues in the path of the rays, the greatest effect being where it is the strongest. In this case the rays were directed into the mouth of the patient, and accordingly they would be the strongest there. If plaintiff were required to use his hand to hold down his lower lip and jaw, as he claimed he was directed to do, it would be reasonable to expect to find the burn the worst, if one should occur on the hand, where the hand approached the closest to the path of the rays, namely, on the tips of the fingers. These experts examined the hand of the plaintiff for that purpose, but found no evidence at all of burns on those parts of the fingers. Plaintiff could not then say that his hand might have been so placed to his mouth that the back of it came into contact with the rays, while the fingers were out of the way. The simple experiment will show that the rays would probably be cut off altogether from passing into the mouth if the hand were so placed. The only reasonable explanation of the condition of the hand then was that it was due to an affection of some kind. This was considered by the experts to be accounted for by the hand coming into contact with the saliva when wiping off his chin, the poisonous saliva getting into an abrasion of some kind on the back of the hand. Each expert so testified, and plaintiff could not dispute it, only by ridicule.

The case was very ably presented to the jury and it rendered its verdict for Dr. Spohn without much delay, and answered favorably each interrogatory propounded by defendant. Dr. Spohn's testimony was so clear and

free from contradictions, and his statements were so accurately supported by his assistant, that the jury could. not do otherwise than believe the defense. The case was too clear to leave any doubt. The point on which there seemed to be the greatest danger-that of the alleged burn to the hand-proved to be not so difficult when once the real nature of it was known. Plaintiff had no expert, save a few depositions of physicians who were not present, to contradict defendant's experts, whose opinions were unanswerable.

This experience of Dr. Spohn illustrates the necessity of proper self-protection in the performance of services, particularly when the services are somewhat of a new and untried nature. If Dr. Spohn had not provided himself with an assistant who could remember the details of the treatments along with himself, and had been careful to make a note of all that he did, the defense would not have been so easy to present, nor so forcefu! when presented. When a witness takes the stand and speaks with a certainty and a positiveness which carries with him an absolute guarantee of the truth of what he says, a court cannot overlook the force of the testimony, and the jury cannot but give it due weight and be controlled by it, particularly when the testimony of the witnesses for the other side savors of falsehood from start to finish. This was the case here. The jury could not do otherwise than believe the defendant's testimony in regard to the use of the protection, when it had previously listened to the testimony of the plaintiff. There was no chance for comparison.

There is little likelihood that the case will be appealed, although there is need of a precedent, there having been heretofore no X-ray case ever decided in any Supreme court in the country. This case is so plainly one of fact that there is little chance of the Appellate Court reviewing it. It will assist in removing a sense of timidity which practitioners cannot help having in the use of the X-ray for the treatment of their patients. It is apparent by this case that the court did not consider that the defendant had made such a departure from the recognized methods of his school that he would be liable for any injury, whether or no he was negligent. But he recognized the X-ray treatment as one being quite generally adopted and used, and that the practitioner using it would be liable for ordinary negligence and for failure to exercise ordinary skill and care, just as any physician or surgeon is held.-Med. Legal Bull.

X-RAY SUIT UNSUCCESSUL.

A suit of interest to physicians has just been decided by Justice O'Gorman in the Supreme Court, who dismissed the damage suit of Miss Josephine MacDonald against Nelson T. Shields and G. F. Jernigan, dentists, and M. J. O'Connor, X-ray specialist, without letting it go to the jury. She sued to recover $50,000 for damages she alleged she sustained through an X-ray examination made on her by O'Connor, under the supervision of the other two defendants, whom she had consulted as dentists, in regard to the condition of her teeth. She was severely burned by the rays, and her hair fell out, leaving her bald. Justice O'Gorman decides that Shields

had nothing to do with the operation, which was entirely under the supervision of O'Connor, and that he cannot be held liable because the plaintiff had voluntarily submitted to the examination. As to Jernigan, Justice O'Gorman held that he was merely an assistant to Shields and was not liable either. Moreover, as O'Connor had not been served with any summons or complaint in the action, no case could be made out against him. Miss MacDonald asserted that she had not gone voluntarily to O'Connor's office, but had been taken there by Shields and Jernigan without being told what the purpose of the visit was. Justice O'Gorman held that the preponderance of the evidence showed that she had consented to the operation. Miss MacDonald's counsel announced that an appeal would immediately be taken.Medical News.

The office of X-ray expert and electrical diagnostician of the law department of Chicago has been created, and will be filled by Dr. H. Preston Pratt. City Attorney John E. Owens says this office has become necessary on account of the numerous attempts at fraud in claims

against the city for personal injuries.

In a personal injury suit in the Circuit Court in Kansas City the plaintiff requested the appointment of a physician to make an examination of the defendant's alleged injury with the X-ray. The court, which was presided over by Judge James Gibson, refused to make the order on the ground that X-ray examinations were always accompanied by more or less danger to the person examined, and that he did not wish to be responsible for any injury which might possibly follow his order.K. C. Med. Index-Lancet.

Pulmonary Embolism After Fracture of the Thigh.Gayet states that a correct understanding of the principle underlying this article may enable one to explain a death which might otherwise have remained unclear, hence it is reproduced in part. A large cask of wine rolled over the individual in question and fractured his thigh. All went well till the seventeenth day after the accident, when febrile symptoms appeared without any apparent cause. Five days later the patient suddenly became asphyxiated, dying in a few minutes. The autopsy revealed a thrombus filling the iliac artery on the affected side, from which a portion was seen to have broken off, and in the pulmonary artery on the left side was caught an embolus which appeared to conform to the outlines of the iliac thrombus. Now it is clear that the fever was due to a phlebitis, and the author blames himself for not having immobilized the leg and thus prevented the separation of a part of the clot, with its fatal consequences. Interstate Med. Jour.

Never forget that wounds of the ciliary region are most dangerous, and if they involve the lens, or if they are attended with loss of vitreous, they need excision of the eye. Fenwick.

Never trust the nurse with verbal instructions for washing out the baby's eyes in infantile ophthalmia. Show her yourself how to do it.-Fenwick.