some of the most important medical discoveries of recent times, namely, in relation to the transmission of yellow fever, the affirmation of the baterial cause of dysentery and the relation of gall stones and cholangitis to pancreatic disease." This part is devoted principally to gastro-intestinal diseases, typhoid fever occupying practically one-third of the space. It is very satisfactory and the hope of its distinguished editor that the two volumes give "a fairly complete resume of the best literature of the year on general medicine" is well founded.

"A Practical Treatise on Smallpox." By George Henry Fox, A. M., M. D., Consulting Dermatologist to the New York City Department of Health, with the collaboration of S. Dana Hubbard, M. D., Sigmund Pollitzer, M. D., John H. Huddleston, M. D. Ten colored plates, six black and white plates. Philadelphia: J. B. Lippincott Company, 1902. Price, $3.00.

The chief features of this work are the plain and colored plates, which represent the various stages of variola; also some showing varicella and vaccinia. From an experience of many years in the Chicago Health Department the reviewer can testify as to their accuracy.

In view of the present wide spread wide spread of this loathsome disease, the work should be of great value to practitioners, especially those in rural or isolated communities. GEORGE C. HUNT.

"International Clinics." Vol. III, Eleventh Series, 1901. Philadelphia: J. B. Lippincott Company, 1901. Cloth, 2.00; half leather, $2.25.

The present number of this series contains, as usual, several interesting papers. The opening one is on Finsen's Method of Phototherapy, by Valdemar Bie, an assistant in Finsen's laboratory at Copenhagen. The paper is illustrated by numerous cuts and plates, showing the apparatus, patients before and after treatment, etc. There are 17 other papers on Therapeutics, Medicine and Neurology. The surgical papers are 10 in number, four on Appendicitis. One of the most interesting articles in the volume is the one by our associate professor, Thomas H. Manley of New York City, on Strangulated and Gangrenous Hernia, Primary Resection of the Intestine by Modified Connell Method, etc. The rest of the volume contains two articles on eye and throat diseases and a closing one on the Clinical Laboratory in Private Practice and in the Physician's Office, by Dr. C. N. B. Camac of New York City.

"Progressive Medicine, Vol. II, June, 1902." A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M. D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo, cloth, 440 pages, 28 illustrations. Per volume, $2.50, by express prepaid to any address. Per annum, in four cloth bound volumes, $10. Philadelphia and New York: Lea Brothers & Co.

This volume contains chapters on Surgery of the Abdomen, by Dr. W. B. Coley; Gynecology, by Dr. J. G. Clark; Diseases of the Blood and Ductless Glands, by Dr. Alfred Stengel, and Ophthalmology, by Dr. Edward Jackson.

The opening section of Dr. Coley's article is devoted to penetrating shot wounds of the abdomen. In conclusion

he states: "The facts brought out by Fenner, based upon a large series of cases treated at the Charity Hospital of New Orleans, cannot but convince the unprejudiced mind that operative interference in the hands of a skilful surgeon, resorted to as soon as possible after the penetrating" wound of the abdomen has been observed, will save a far greater proportion of lives than the old laissez faire' methods of a few years ago." A thorough account of tuberculosis of the peritoneum is also given.

The volume, as usual, contains a good account of the progress made in the various departments of medicine considered.

PAMPHLETS RECEIVED.

"A New Ophthalmoscope," by Brown Pusey. "Dermoid Tumors," by William Davis Foster, M. D., of Kansas City, Mo.

"The Technics of Nephropexy, as an Operation per se, and as Modified by Lumbar Appendicectomy and Lumbar Exploration of the Bile Passages-Migrated Ovarian and Parovarian Tumors-On Bandages for Nephroptosis Is the Kraske Operation Justifiable in Women?-Panhystero Kolpectomy: A New Prolapsus Operation-The Cure of Chronic Bright's Disease by Operation," by George M. Edebohls, A. M., M. D., of New York.

"Symposium on Appendicitis at the Cuyahoga County Medical Society." (From the Cleveland Medical Gazette.)

"The Uses of Tuberculin," by Charles Denison, A. M., M. D., of Denver, Colo.

"A New Localizer for Determining the Position of Foreign Bodies in the Eye by the Roentgen Ray--Implantation of a Gold Ball for the Better Support of an Artificial Eye-Vernal Conjunctivitis-Gold Blindness or Retinal Asthenopia and Its Treatment," by L. Webster Fox, A. M., M. D., of Philadelphia, Pa.

"The Management of the Tendency of the Upper Fragment to Tilt Forward in Fractures of the Upper Third of the Femur," by Russel A. Hibbs, M. D., of New York.

"Papillo-Retinitis Due to Chlorosis-Two Cases in Which Eye Strain Was Relieved by Vertical Decentration of Lenses," by Cassius D. Wescott, M. D., and Brown Pusey, M. D., of Chicago.

"Surgical Interest of the Sub-Peritoneal TissueGastrostomy and Retrograde Dilatation in impermeable Benign Traumatic Stricture of the Esophagus and Internal Esophagotomy by the Abbe Saw String MethodCholecystostomy-Typhoid Perforation, Its Frequency, Prognosis, Diagnosis and Treatment," by Hugh M. Taylor, M. D., of Richmond, Va.

In non-penetrating wounds of the abdominal wall there is usually comparatively little shock or bleeding, although the latter point varies, of course, with the position and nature of the injury. Unless the wound becomes infected and suppuration occurs the patient does perfectly well.Cheyne and Burkhard.

Foreign bodies in the stomach are very common, but the majority are insignificant and cause no trouble; they find their way along the alimentary canal and are passed per rectum.-Cheyne & Burkhard.

Railway Miscellany.

PHILADELPHIA & READING PENSION SYSTEM.

The Philadelphia & Reading has decided to adopt a pension plan for its employes, the first step having been taken on May 21, when the directors authorized President Baer and the executive committee to prepare and put into effect a pension system to supplement the Philadelphia & Reading Relief Association, and to provide for employes who cannot be reached by the Relief Association. It is intended that a similar pension system shall be adopted by all of the transportation companies which the Reading Company owns or controls. All employes who have attained the age of seventyfive years are to be retired, and if they have been in the service of the company 30 years they are to be pensioned, provided, however, that this provision shall not be mandatory in its application to executive officers appointed by the board of directors. All employes sixty-five to sixty-nine years of age, both inclusive, who have been thirty or more years in the service, and who have become incapacitated, may be retired and pensioned. The monthly allowance paid each person granted a pension shall be: For each year of service, 1 per centum of the average regular monthly pay for ten years next preceding retirement. The acceptance of a pension allowance shall not debar any former employe from engaging in other business, but such person cannot re-enter the service of the companies. The pension board shall have power, in case a faithful employe of the company shall have received injuries which totally incapacitate him for his regular or other vocation, to take his case under consideration and award him such sum, as a pension, for such length of time as the board shall determine. No person is to be taken into the service of the company who is over thirty-five years of age. As to this age limit for employment, however, the folowing exceptions, if the board of directors approves, are to be made: Former employes may be re-employed within a period of three years from the time of their leaving the service, or former employes of any other transportation company owned or controlled by the Reading Company may be employed within a period of three years from the time of their leaving the service of such company; persons may, irrespective of age limit, be employed, where the service for which they are needed requires professional or other special qualifications; persons may be temporarily taken into the service, irrespective of age limit, for a period not exceeding six months, subject to extension, when necessary to complete the work for which engaged, and persons in the active service of any transportation company owned or controlled by the Reading Company may, irrespective of age limit, be transferred to and employed in the service of any such compary.

"'ROAD,'' ''ROUTE," "SYSTEM."'

The "Rock Island System" is hereafter to replace the "Great Rock Island Route" as the official trademark for the aggregation of corporations which the Chicago Rock Island & Pacific Railway Company now dominates and includes. The announcement is another illustration of the progress of railway evolution in these rapid days, under which a railroad consisting a generation ago of 180 miles of ill laid track, lying in a single State, has grown into a system of 7,000 miles, multiplied into lines almost innumerable, radiating into more than a dozen States and Territories.

It was first the Chicago & Rock Island Railroad Company, chartered in 1851, whose single track 185 miles long reached the Mississippi in July, 1854, forty-eight years ago, and connected a little city on Lake Michigan with a little village on the great river. The Mississippi, broad and unbridged then in all its course, at first bounded the ambitions of the projectors of this pioneer line. But in 1866, the then wonderful work of bridging the Father of Waters being accomplished and the westward extension having been commenced under the name of the Mississippi & Missouri Rail

road Company, the two roads were consolidated under the title of the Chicago Rock Island & Pacific railroad, and in 1869 the Missouri River was reached at Council Bluffs. Then there was "one more river to cross." After an interval of years the Chicago Kansas & Nebraska Railway Company took up the work of extension beyond the Missouri into Kansas and beyond, and was absorbed into the parent company in 1891, the combined roads having developed by this time into the "Great Rock Island Route." Still later the Chicago Rock Island & Texas gave title to a long extension to southwestern points, and the Chicago Rock Island & Mexico and subordinate companies have but recently carried the line on to the Mexican border, a straight distance of 1,465 miles from Chicago. Meantime the growth has been going on west, north and south, by construction and purchase, until the old tap root from Chicago to Rock Island has spread out into many lines, reaching from Illinois into Iowa, Missouri, Kansas, Nebraska, Oklahoma, Indian Territory, Texas, New Mexico, Colorado, Minnesota, South Dakota, Arkansas and Tennessee. The little city of Rock Island, which formed the terminus of the original line, is now a waystation through which pours the traffic of 7,000 miles of road, but is still honored and advertised to the world by giving its name to the "Rock Island System," to whose growth no bounds now seem to be set. The little Rock Island road of 180 miles in 1854, which had increased to 4,300 miles at the beginning of the present year, has within a few weeks added nearly 2,700 miles more, and the aggregation now foots up as follows:

It was the "Great Rock Island Route" when the mileage was small compared to that of neighboring systems; now that it has leaped to a place among the greatest, with great plans of extension and absorption yet to be fulfilled, it has dropped adjectives and risen to the dignity of the simplest possible designation "Rock Island System." Orders have been issued that the new title shall succeed to the old on all cars, signs, stationery, maps, folders, tickets and other forms of official reading matter, and the dozen or more corporate titles that must maintain a legal existence will disappear from the public eye, replaced for all practical purposes by the two words, Rock Island, which told the destination of the road as it commenced its growth forty-eight years ago.

The Minnesota State Board of Health has notified the various railways that their trainmen and depot men must be vaccinated.

The Pullman Company has been sued in the District Court of the United States of New Jersey for $5,000 damages by Rev. T. Johnson, editor of the organ of the African Methodist Episcopal Church. The complaint is that the persons in charge of a Pullman dining car refused to furnish him with breakfast on a journey from Richmond to Washington,

When a freight conductor permits a person to ride on his train against the rules of his company and the person is injured the company cannot be held for damages under the same rules requiring care that apply in the case of passengers on a regular passenger train. So holds the Ohio Supreme Court, in the case of the B. & O. Rd. vs. Mary J. Cox, executrix.

Electric railways are not exempt from the trials of bigger railways in the matter of personal injury damage claims. Thus, the Southern Ohio Traction Company has been sued for $5,000 by a young woman of Middletown, who claims while she was getting off a car she was struck in the forehead by a revolving brake handle, and that the resulting scar has permanently marred her beauty. But this is a small

demand compared with one that has been filed against the Big Four Railway at Indianapolis by a commercial traveler, Mr. Leopold Meyer, who claims that in passing from a sleeping car to a smoker he was thrown off the platform by a sudden lurch of the train and was seriously injured and disabled, for which he asks $100,000.

The total benefits paid out by the relief department of the Pennsylvania Lines West of Pittsburg during the month of March, 1902, amounted to $38,015,65, out of which $6,900 was paid for twelve cases of accidental death, $10,500 for seventeen cases of natural death. The disablement benefits amounted to $10,116.85 for cases of accident and $10,498.80 for cases of sickness.

The British Board of Trade report for 1901 makes the remarkable statement, as cabled, that not one passenger was killed in a railway accident during the year. Eleven railway employes and persons other than passengers were killed and 161 injured. The number of passengers injured is reported at 476, which is disproportionate to the other figures and suggests the possibility of error in the brief telegraphed report.

Michael Mooney fell from a bridge and was injured, and in due time sued the Pennsylvania Railroad Company for damages, claiming that the structure was defective. The trial court gave him no relief and the Pennsylvania Supreme Court concurs, with the unfeeling remarks: "Unless we hold that the defendant company is responsible for the effect on the plaintiff of the 'York State cider' and Nanticoke gin consumed by him on the day of the accident we must sustain this result. They, and not the negligence of the defendant, were the cause of his injuries."

During the month of February, 1902, the relief department of the Baltimore & Ohio paid benefits to the amount of $38,859.66. Out of this $9,500 was paid account of accidental death; $10,899.29 accidental injuries; $1,080.22, surgical expenses: $12,380.15, natural sickness. and $5,000, natural death. The relief department of the Cleveland Terminal & Valley has issued a statement for the four months ended on February 28, 1902. The total benefits were $2,025.55. This amount was apportioned as follows: Accidental injuries. $1,068.70; surgical expenses, $171.60; natural sickness, $785.25.

The verdict of a jury at Trinity, Texas, in awarding $15,000 damages to the widow of a man who was run over and killed by a car on the track of the Missouri Kansas & Texas, has been reversed and remanded by the Court of Civil Appeals at San Antonio, Tex. It was found that the deceased was not at a crossing when killed and was not in the act of crossing a track, but had stopped to examine the coupler on a car and was in the act of kicking the coupler when the car was moved and ran over him. The court says that he was engaged in gratifying an idle curiosity in regard to an appliance, and the company owed him no duty, as it did not know that he was on the track.

According to a Boston paper the Boston & Maine has decided to discontinue the oiling of its roadbed after a three years' test. The Boston Herald, which gives this information, says: "Ladies have complained that delicately wrought fabrics are marred by the particles that settle upon them when riding over a road treated in this manner, and objection has also been raised by male passengers, whose white shirt fronts and collars have been polka-dotted from the petroleum veneer. There are counterbalancing benefits, however, and if it were possible to secure opinions from all the patrons of the Boston & Maine, the vote would be very evenly divided. Those who use the road three or four times a week would not be found in the opposing column, as when they travel their best clothes are left at home. The Boston & Albany, another road that experimented with oil, is also to abandon it and substitute rock ballast. This work will be inaugurated as soon as a plant for the production of the necessary material can be installed. It will be an expensive undertaking, but by covering about 15 miles a year the burden of the outlay will be felt less than if it were done quickly. Portions of the roadbed that have been covered

with broken stone give satisfying results, and the company feels assured that when the entire line has been similarly treated, and the rails rebonded after the standard of the main line of the New York Central, nothing further could be desired by the most exacting patron. The New York New Haven & Hartford is also engaged in the dust-laying business. Two-thirds of the line between New London and New Haven has been rock ballasted, and work on the remaining portion is being vigorously pushed. Down on the Plymouth division, where the line runs through light sand, thousands of loads of cinders have been spread, giving one of the finest roadbeds possible to make."

man.

The principle of contributory negligence has been disregarded by a jury at Franklin, Ind., in a suit against the Toledo St. Louis & Western Railway by C. J. Long, a trainIn December, 1900, Long's train collided with another, causing a loss to the railway company of $7,000. Long subsequently asked for his wages, but the company refused, claiming that he had contributed to the accident by negligence. The Brotherhood of Railway Trainmen retained counsel, who brought suit in Long's name, and the jury gave plaintiff a verdict for $70, being the legal penalty of double the amount and attorney's fees. The case will be taken to the Appellate Court, which may not coincide with the view of the jury in the local court.

Railway companies are not responsible for all conceivable forms of injury which may be suffered by people while riding on their trains, it seems from a decision of the United States Circuit Court at Indianapolis in the case of Britt against the Lake Erie & St. Louis Railway Company. An unknown person threw a walnut against a car window at which Britt was sitting. The glass was broken and a fragment struck the passenger's eye and he asked for damages against the railway. The court held that the law does not impose the duty on railroads of protecting their passengers from the criminal acts of unknown persons; that the act complained of constitutes a criminal offense punishable by fine and imprisonment and that it is not the duty of railway companies to arrest and cause the punishment of such criminals.

In the conduct of railway operation or any of its collateral branches, nothing is more conducive to success than the good-will of the people to whom dependence is had for patronage. There are necessarily some demands made by the people which cannot be granted, as there are some practices attempted by the railroads which cannot be defended, but wherever possible it is manifestly good policy to cultivate harmony. Realizing this, the Central of Georgia Railroad has adopted a practice in connection with its sleeping car service (which is operated independently by that road) that the Pullman Company might do well to follow. With the last-named company the rule is imperative that at night the upper section shall always be lowered into place whether occupied or not. On the Central of Georgia the upper section is lowered into place only when actually in use, thereby allowing more room, better ventilation, and altogether more agreeable quarters for the occupant of the lower berth than under the Pullman regulation. It is, of course, true that this concession on the part of the Central of Georgia contributes in a small way to diminish its income, as sometimes a party desiring the comfort of the additional room and able to pay for it, buys the entire section, although occupying only the lower berth, but it is not believed that the loss offsets the gain in the way of good-will which the people have in consequence of the privilege. It should be said, on behalf of the Pullman Company, that the claim is made, that to make up the upper berth after the lower is occupied, as would sometimes be necessary, would cause more annoyance than to lower the upper berth in the first place. That is, however, rather in the nature of an excuse, the real reason for the Pullman practice being one of revenue, which under the circumstances is hardly competent. The earnings of the Pullman Company, according to its own reports, are abundantly large to warrant such a reduction, and in view of the public favor which might thereby be engendered it would seem to be the part of wisdom to adopt the other plan.

Surgeon

VOL. IX.

INFECTED FINGERS.*

BY H. A. LEIPZIGER, M. D., BURLINGTON, IOWA.

To the average attendant upon medical and surgical conventions it must have appeared as it has to me, that a great deal of industry and energy is expended by readers of papers upon subjects difficult to grasp by the average practitioner, and often of less practical beneft to him than simpler themes and more familiar ones. Let this not be understood as a lack of appreciation of the value of reports of stupendous operations brilliantly executed, or of scholarly reports of ultra-scientific research. Far from it! Neither our societies, nor indeed our profession, could proceed or progress without essays and presentations of just such high character. But it is very well to occasionally-I prefer to say frequently-descend from the high plane of rare and unusual cases to those which confront us every day and give the every day doctor no end of worry and trouble-I mean the so-called minor surgical ailments, and among these perhaps none are more numerous or can at times become more trouble

some than infected fingers. To justify the importance I place upon this class of surgical diseases, I wish to formulate at the outset the proposition that there is no such thing as minor surgical disease nor a minor surgical operation. In the days when bacteria and their acknowledged influences were unknown it may have been quite proper to call an infection of the arm a major trouble and that of a finger a minor one; or it may have made a difference in the size of the operation if the array of surgical instruments and paraphernalia were large in one case or small in the other.

But in these days we have every reason to regard every surgical procedure as a serious affair. There is, to be sure, a vast difference between one operation and another. The amount of skill, knowledge, experience and responsiThe amount of skill, knowledge, experience and responsibility in various procedures properly constitute a grade of magnitude in the operation, but no surgical operation of magnitude in the operation, but no surgical operation is a minor one which entails danger of life or limb or health, or threatens either of these, and there is no sur

gical procedure however trifling apparently-which may not involve either or all of these dangers. Knowing as we do that an infinitesimal quantity of infectious material may, and often does, kill the patient, we should abandon such terms as "opening boils" and "lancing fingers." Fingers that have been "lanced" do sometimes, perhaps, frequently get well, and so do some that are left alone. But the surgeon who only poultices and "lances" his cases of infected fingers will surely have a

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

No 2

longer list of maimed hands or of patients lost by sepsis than his colleague who operates on his cases and treats every case of infected finger as a major surgical disorder. And in this view the laity should be enlightened and instructed at every opportunity.

To treat properly an infected finger involves always a high degree of surgical knowledge and sound judgment. To a man who is thoroughly informed upon the anatomy of the parts and the pathology of the disease the infected finger offers a grateful field for nice scientific surgical work; to one less thoroughly equipped the case presents. questions of judgment as to whether he shal! cut or leave it alone frequently letting it alone is better than unskilful cutting. I believe all cases of poisoned fingers are most safely treated by careful, painstaking operation, safer for the life and for the limb of the patient.

To operate on such cases means the careful separation of the infective material and for its complete removal. of all the valuable parts of the finger in a search for all This means frequently extensive cutting and dissecting; it will mean a great deal to the patient whether a tendon erated or healthy periosteum denuded or removed. On is severed, a sheath opened, a nerve cut, a vessel oblitthe other hand, the judgment of the surgeon is often taxed to decide whether it is better to at once remove a finger or portion of it than to take chances of letting the infection travel further upward.

My own practice, when a patient declines to have a

finger operated upon-I never agree to lance it—is to give the finger forty-eight hours' chance of recuperation

by the use of hot applications of boric acid solution. This, of course, in the early part of the infection, or when they come, as they frequently do, after having been "lanced" by someone else. If at the end of that time there is indication for operation, I insist upon a general anesthetic being given-unless contraindicated-so that I can operate with leisure and accuracy. I prefer general to local anesthesia because, firstly, the patient's nervous system anesthesia because, firstly, the patient's nervous system has usually been demoralized by pain, anxiety and some sepsis at the time, and his mental condition is less shocked by the operation done this way, and, secondly, under local anesthesia one is more apt to be hurried and less thorough in the work and consequently the result is not so good. When the case if very painful the pain is apt to make considerable inroads on the patient's stamina, and it is eminently proper that everything should be done to give him the promptest and most complete relief. If I have my own way from the beginning I incise the finger before I am assured of the location of the pus, and separating the tissues by retractors split the parts until the focus of infection is found, and then apply antiseptic irrigation

of corrosive sublimate solution and packing. To be sure, one is apt to hear that this incision is responsible for the subsequent progress of the infection, the loss of a piece of tendon or a necrosed phalanx, because the pus focus is frequently near or at the periosteum and has begun its evil work upon the bone before the patient is seen.

To determine the location of pus in the beginning is difficult, because fluctuation is very deceptive in the normally elastic soft parts of the fingers, especially the finger tips, and the pus collection is very slight at this time and not appreciable through the thick palmar skin. The best way to locate the incision in such cases is by palpating with a probe or pencil to find the point of greatest pain and make the incision at this point. Should the pus be found in the tendon sheath the incision should be enlarged and the sheath split open to the extent of one-half to one inch, care being taken to always keep the skin incision longer than any internal one. Whenever the disease has extended along the phalanges the incision should be prolonged if necessary the whole length of the finger; nothing is gained by small incisions and working in the dark. If the palm is invaded, tranverse incisions are more desirable and perhaps less apt to bring on hemorrhage from the arch. It is presumed that the strictest. antisepsis is observed in cleaning the hand for these operations, as they frequently are presented soaked for days in the grease and plasters of poultices and applications. After the infection has ascended the arm much can still be done to save tendons and other tissues by incisions, drainage by tubing communicating from one opening to another and continuous antiseptic irrigation, beginning at the highest opening and arranging the tubes so that the solution used will find exit in the opening furthest below. Among the best solutions for continuous irrigation are Thiersch's or salicylic acid solution alone, or a solution of Ecchafolta, which is an alcoholic extract of a vegetable antiseptic. The irrigation can be made to flow drop by drop and will be more effective than when running in a stream.

In conclusion:

I. Let us have no more lancing of infected fingers. There is a time when simple incision is indicated, but that is so early that patients are seldom scen at that time.

2. Always explain the gravity of the case to the patient and caution him that sloughing or necrosis may follow your operation, not as a result thereof, but because the poison may have already done the damage before you have begun.

3. Give a general anesthetic.

4. Prepare the field of operation as carefully as you would for any antiseptic operation; asepsis is out of the question.

5. Operate thoroughly and carefully, as every portion of tissue is important to the function of the fingers.

6. The doctors who lance these fingers get paid for lancing and get perhaps all their services are worth; the surgeon who treats these cases correctly does skilful surgery and deserves and should demand higher compensation than is usually considered applicable to this class of cases.

7. The laity should be instructed in the truths of these propositions.

DISCUSSION.

Dr. R. Ortega of Mexico said he had been very much. interested in the paper of Dr. Leipziger. He had treated. infected fingers with a solution of bicarbonate of soda, which not only relieves the pain, but controls pus, so that it is not necessary, in many instances, to incise the parts. He does not believe a surgeon should cut his fingernails short, but should use a file to get rid of the material which accumulates in the subungual spaces. He exhibited a file which he uses, and by its use he believes the fingernails of the surgeon and the subungual spaces can be kept clean and the liability on part of the surgeon to infect a patient with dirty fingernails is not so great.

Dr. W. S. Hoy of Wellston, O.: I fear that the members present do not understand the last speaker (Dr. Ortega) in reference to his explanation of infection of fingers. If I understood him, he attempted to show by blackboard demonstrations that a great many of these infected fingers are caused by ourselves. I am satisfied that if the paper of Dr. Leipziger is properly understood (and I think it has been by the majority of members present), the railway surgeon to-day realizes one thing— that while it may seem a minor consideration in the field of surgery, it is nevertheless one of the most important with which we have to deal. Let us take into consideration the majority of injuries that are received on railroads. They are of the contused or lacerated variety, and a great many of the injuries we encounter result in abscesses, with infection following, and it becomes the duty of the surgeon to understand how best to manage the case in hand. I am a great believer in continuous irrigation in the treatment of infected fingers after they have once been opened, and if I find there is the formation of pus I use strong carbolic acid, having no fear if it is followed by the use of alcohol. I have not had many of these cases to deal with, yet I have seen fingers which were badly infected. The great principle involved in the consideration of this subject is how best to treat infected fingers when they come under our observation. I believe that if we use plenty of gray matter in the treatment of these cases and exercise our best judgment, we will get along very much better than we do.

Dr. Gardner of Indian Territory: The paper which we have just heard is an admirable one, but I do not think the essayist has elaborated the subject to the fullest extent. I have had a good deal of experience recently with infected fingers. I had one case of infection which was secondary to any erysipelas case in a house. The erysipelatous process extended up the arm, and began from an infection of a little skin blister on the knuckle of a finger in a coal miner. He was infected from a case of erysipelas in another member of the family. I believe in the doctor's method of irrigation and packing, and all that sort of thing, but I believe in opening the infected part and dissecting it out rather freely, getting clear to the bottom, then cauterizing it with pure carbolic acid. If the infection extends deeper, I make incisions in the skin, going through the whole thickness of the skin to the deep fascia, then painting the parts will pure carbolic acid as far as I think the infection extends. I have treated several cases of erysipelas in that way; then washed off the carbolic acid immediately with pure alcohol.