the ankle-joint, which tends to keep the foot from being dislocated outward, seemed to have disappeared entirely or never to have been present. The only feasible thing seemed to be to remove the astralagus, which the speaker did by making a vertical incision, commencing about 11⁄2 inches above the tip of the internal melleolus and carrying it down on the side of the os calcis, drawing the tendons aside and removing the astralagus from the inside. The typical incisions for the removal of the astralagus are all upon the outer side of the foot. In the reports of the American Ortheopedic Association, in a somewhat similar case reported by Dr. Moore (Vol. VIII., p. 15), some one took him to task because he had made this same incision on the inside, suggesting that it was more natural and better to make the incision on the outer

side. That is very good from a theoretical standpoint, but from a practical standpoint one wants to make the incision where it will best accomplish the work; and in this case it would have been extremely awkward to have removed the astralagus by making an incision from the outer side, whereas by making it on the inner side. it was comparatively easy matter. After the removal of the astralagus the fibrous structures on the inner side of the os calcis were sutured to the periosteum of the internal malleolus with chromicized catgut, the greater portion of the wound closed, leaving an opening for drainage, and a large absorbent dressing applied covered by plaster of paris. This was removed in eight days, the wound having healed by first intention, and at the end of three weeks the patient was allowed to walk on his foot.

The tendency in flat foot is to evert the foot. This patient has just commenced to walk, and is taking his own ideas about locomotion, but it is observed that he does not turn his toes outward.

In the article in which Moore reports his case he makes the statement that, so far as he knew, he was the first one in this country to remove the astralagus for this condition. The case he operated on was a woman, twenty years of age, who had the internal ligament of the ankle cut when a child by stepping on a piece of glass that produced very much the same condition of affairs, but to a lesser degree than in this case. There did not seem to be anything to keep the foot in position; the ligament seemed to be absent. The injured foot showed extreme flat foot with the inner side of the great toe turned almost directly outward. She had grown gradually worse for some years and had to give up her employment as a domestic on account of the severe pain. He operated and removed the astragalus, and states that she recovered from her disability with a very satisfactory result.-Brooklyn Medical Journal.

PERSONAL.

Dr. James T. Jelks, consulting surgeon for the Mis souri Pacific, at Hot Sprinks, Ark., died there recently.

Dr. James Hayes, surgeon of the Grand Trunk, at Simcoe, Ont., died there on May 31, 1902.

Dr. J. C. Cassaty of Shelbyville, Ky., has been appointed surgeon for the L. and N.

Dr. Louis Howe has gone from Spearfish, S. D., to Cody, Wyo., to locate, having been appointed Burlington surgeon for that line of the company's road.

Notices and Reviews.

SAUNDERS' MEDICAL HAND ATLASES.

"Atlas and Epitome of Otology." By Gustav Brühl, M. D. of Berlin, with the collaboration of Prof. A. Politzer of Vienna. Authorized translation from the German. Edited by S. MacCuen Smith, M. D., Clinical Professor of Otology, Jefferson Medical College, Philadelphia, Containing 99 text illustrations and 244 colored figures on 39 lithographic plates, with 64 pages of descriptive index thereof, in addition to 292 pages of text in the Epitome. Philadelphia and London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1902. Cloth. $3.00 net.

In accord with the other atlases of the Saunders' series, this is an invaluable work, as would be assured by the names of the distinguished authors, as well as by that of its American editor.

The colored illustrations represent the highest standard of the printer's art in work of this kind, and by their assistance the reader will secure an accurate guide to the anatomy of the ear, as well as a thorough reproduction of its several pathologic conditions. Opposite each plate is a carefully prepared descriptive index, whereby much help is given in the direction of diagnosis. The didactic portion of the work given in the epitome is tersely written, and in addition to a good description of the anatomy of the parts, elucidates the numerous questions involved in diagnosis and treatment.

It is observed that in the practice of Politzerization the antiquated rubber handbag is adhered to instead of the more modern, exact and efficient method of using compressed air with medicated nebulæ in office practice-an American custom, the knowledge of which has apparently not as yet reached European shores.

A considerable description of massage in the practice of otology is given, and illustrations shown of two mechanical masseurs, which places it in this respect somewhat in advance of other recent works on this subject. Many of the text illustrations are of particular merit, especially those classified as diagrammatic.

An excellent quality of paper is employed and the print is clear and of good size. An appendix with a variety of formulæ is included. In fact, within the confines of this epitome is to be found more of otology in fewer words than is elsewhere available. For this reason, as well as owing to the fact that the colored plates are unsurpassed, this atlas should be in the library of every otologist. EDWIN PYNCHON.

"A Treatise on Surgery by American Authors." For Students and Practitioners of Medicine and Surgery. Edited by Roswell Park, M. D., Professor of Surgery in the University of Buffalo, N. Y. New ((third) edition in one royal octavo volume of 1,350 pages, with 692 engravings and 64 full-page plates in colors and monochrome, Philadelphia and New York: Lea Brothers & Co. 1901. Cloth, $7.00, net; leather, $8.00, net.

This edition of Park's "Surgery" has been brought entirely up to date by the addition of a new chapter and revision of others and has been greatly improved by the addition of many new and excellent cuts.

The chapters on Hyperemia and Inflammation have been handled in a masterly manner by Professor Park and are worthy of special notice. Likewise those on Blood Examination and Bacteriology are much in advance of the

Railway Miscellany.

JOHN N. FAITHORN.

The appointment, announced elsewhere, of Mr. J. N. Faithorn to the vice-presidency of the Chicago & Alton in charge of traffic, while he still retains his previous position as president and general manager of the Chicago Terminal Transfer Railroad, may be considered as a special recognition of a successful career devoted entirely to traffic interests. By this move Mr. Faithorn returns to the road with which his earliest experience was gained, he having entered the service of that road in 1875 at the age of twenty-three as clerk in the freight department. In 1885 he became auditor of the Southwestern Railway Associa

JOHN N. FAITHORN.

tion, and in April, 1887, commissioner of the Western Freight and Northwestern Freight associations. Subsequently he held the following positions: Commissioner of the Western and Northwestern Freight Bureau, chairman of the Western Freight Association, chairman of the Southwestern Railway and Steamship Association, commissioner of the Western Freight Association, vice-president and general manager for Street's Western Stable Car Company, general manager Wisconsin & Michigan, president and general manager of the Peoria & Northern, August 1, 1899, he was made president and general manager of the Terminal Company.

The relief department of the Pittsburg & Western paid total benefits to the amount of $2,564.40 during the month of March, 1902. Of this, $1,000 was paid for a single case of accidental death; $595.80 was paid for accidental injuries; $40.45 for surgical expenses and $928.15 for cases of natural sickness.

The relief department of the Pittsburg Junction Railroad Company paid benefits amounting to $894.40 for the four months ending on April 30, 1902. Of this amount, $500 was for a single case of accidental death; $204.90 for accidental injuries; $13 for surgical expenses, and $176.50 for natural death.

RAILWAY NOTES AND NEWS.

The relief department of the Baltimore & Ohio paid benefits during the month of March to the amount of $53,232.96. Out of this, $13,585 was paid for cases of accidental death; $11,005.47 for cases of accidental injuries; $984.90 for surgical expenses; $15,177.40 for natural sickness, and $12,480.19 for cases of natural death.

The relief department of the Pittsburg & Western during the month of April, 1902, paid a total of $5.944.40 in benefits. Out of this $4,000 was paid for two cases of accidental death; $719.75 for accidental injuries; $131.75 for surgical expenses; $843.50 for natural sickness, and $250 for cases of natural death.

The relief department of the Baltimore & Ohio paid a total of $51,435.60 in benefits during the month of April, 1902. Of this amount $13,000 was paid for cases of accidental death; $10,995.89 for accidental injuries; $1,369.87 for surgical expenses; $13,866.45 for natural sickness and $12,203.39 for cases of natural death.

Recent publication of a statement that not a passenger was killed on English railroads in 1901, has brought out a claim for the Mexican National that that road, with its branches aggregating 1,200 miles in operation, has for more than 20 years never killed a passenger, though it climbs more mountains and turns more curves than any road in the United States.

The coroner's investigation into the accident in the Sheraden yards of the P. C. C. & St. L. Railroad in Pittsburg on May 12, in which many persons suffered death or injury by the explosion of five cars of naphtha, has just been closed. It finds that the cars of naphtha were cut off from part of the train by Brakeman Howard Bodle and ran into another train, breaking three of the naphtha cars and causing a fire and explosion. The jury censures Bodle for cutting off the cars without orders and recommends that "no cars hauling any inflammable or explosive matter shall be detached from the locomotive until properly placed." The evidence taken indicated that it was not the practice to cut off tank cars in switching and that the brakeman did so in this case without orders from the conductor.

John W. Mackay, extensive owner of gold mines in Nevada and California and largely interested in telegraphs and railways, died at his London home on July 20 at the age of seventy-one years. He was president of the MackayBennett Cable Company, president of the Postal Telegraph Company, president of the prospective Pacific-Commercial Cable Company, director in the Canadian Pacific and Southern Pacific railways, director of the proposed railway from Havana to Santiago in Cuba, a large owner in a sugar refinery and in the Sprague Electric & Elevator Works, and owner of many properties in New York, California and Loudon. His wealth has been estimated at $80,000,000. Mr. Mackay, after early struggles with poverty, laid the foundation of his vast wealth in 1863 by discoveries of gold in what afterward became known as the "Bonanza" mining region.

"The longest interurban electric railway line in the world" is being developed by combination and construction between Cincinnati and Toledo, a distance of 204 miles. The route is by way of Hamilton, Dayton, Troy, Piqua, Lima and Findlay, and covers the lines of four companies, the greater part already constructed. Next spring, it is declared, passengers I will be carried from Toledo to Cincinnati in eight hours, with sleeping, buffet and parlor cars among the attractions, while a through and local freight business will offer further competition to the steam lines. Meantime, another and longer line between the two cities is projected by the Toledo Columbus Springfield & Cincinnati Railway Company, which proposes to put together lines, existing and contemplated, by way of Xenia, Springfield, Bellefontaine and Lima, and announces Its intention to carry passengers, mails, express, baggage and freight, provided the desired $5,000,000 can be raised to build the road.

VOL. IX.

THE RELATIONSHIP EXISTING BETWEEN THE LEGAL AND HOSPITAL DEPARTMENTS

OF RAILWAYS.*

BY HON. ALEXANDER G. COCHRAN, ST. LOUIS, MO., GENERAL SOLICITOR MISSOURI PACIFIC RAILWAY.

The legal and the hospital departments of the Missouri Pacific Railway system are very closely connected. I do not know anybody connected with the Missouri Pacific Railway system with whom I am upon terms of greater intimacy, and who is to me a more delightful companion, than Dr. Outten, who is, as you all know, unfortunately detained from your meeting by reason of the death of a member in his family, but who told me by 'phone this evening that he will have the pleasure of looking in upon

you to-morrow, at least for a little while.

It

I very early realized that after my appointment to the position of general solicitor, which meant, of course, the supervision of all legal matters connected with the system of more than five thousand miles already, it would be necessary to know thoroughly the man who was at the head of the great hospital system of the company. became necessary for me to study the system, to understand it, to be thrown in connection with the doctors who represent us at the principal points upon our line, so that it has been my pleasure to cultivate the acquaintanceship of these gentlemen. If they happened to be in the city they would come to my office, talk with me and tell me about the various matters of interest in their various localities, about the conditions prevailing in the different states and about the general sentiment that exists in regard to our railway system. There is in some parts a certain prejudice against the hospital system. I have found that out. I have had reports from some of our doctors in which a feeling was expressed against the system from some imaginary theory that it is not really to the benefit of the men, and, indeed, in studying the history of our own system, which is one of the pioneers of all these systems in the country, I found in the beginning the men were opposed to it. They did not take to it kindly at all. When the matter was first proposed, in the time of Mr. Talmage, there was opposition developed. It did not take the form of fierce opposition, but nevertheless there was opposition. It was fought because the railroad men would be asked to make a contribution each month toward the support of the system by which it could be maintained, and there was a certain prejudice on that account.

But the hospital system was not in operation very long, under the supervision of Dr. Outten, who was with it

*Stenographic report of address at fifteenth annual meeting I. A. R. S. St. Louis, April 30-May 2, 1902.

No 3

from its infancy, until everybody, I think, connected with the road, began to realize the great benefits which would result from it. And it has grown from a small infant to a stalwart giant; it represents a magnificent position now, and it is supported, not merely by the contributions of the railroad men, but by the warmest sympathies of the men who are interested in it, and I believe this condition of affairs has been brought about largely by the very admirable management of the system by its head, and all those who are under him generally, namely, the doctors connected with it. I am glad to speak of the hospital system in this way, because the results have been

so splendid. Let us suppose there is a wreck on a railroad; some man is badly, injured, bruised, cut, bleeding. pital system? You call in, perhaps, a physician from the What are you going to do with him if you have no hoscountry, a man who has had practically no experience in surgery, a man, perhaps, who is a good enough physician, practicing, as he does, in a little hamlet, with a few families as his patrons, but without any real knowledge of our modern antiseptic surgery, without the implements, without the appliances, and he is called upon suddenly to take care of this patient through a serious illness resulting from wounds. The patient, perhaps, may be well nigh to death by reason of the shock of the wounds, if he does not die at the time for want of proper attention or careful treatment. What sort of treatment can you expect for a wounded man, whether he be a passenger, or an employe, under such conditions as that? Nine out of ten men would hardly know how to deal with such a case under such conditions. But you, gentlemen, are experienced in surgery and are familiar with the marvelous developments that have been made in the last decade.

Now, the hospitals which we have established at different points upon our lines, some of them temporary emergency hospitals, and the more permanent ones at Kansas City and elsewhere, are homes where the wounded can be taken at any time. Here is a man stricken. A local surgeon is called in, he does what is necessary-stops the flow of blood-and the man is sent right on, as soon as possible, to one of the larger hospitals. Here he comes. in immediate contact with the highest skill of the surgeon in charge of the hospital. Here he will receive the very best surgical treatment, and that is what these injured railway employes want, and it is what they are entitled to, and what they must have, and they will get that surgical treatment, which, if given by any first-class reputable surgeon, not connected with the railway system, would cost them four or five hundred dollars for an operation which it might be necessary to perform; whereas, under the hospital system they might not have to pay more than

a few dollars, the mere matter of a deduction of fifty cents a month from their pay for the purpose of maintaining the hospital department. Every attention and medicines are given to these injured men. Of course, this affords also an opportunity to the surgeon to know how a man is injured. Is he permanently injured? He may be so badly injured as to require amputation of a leg or arm. He may claim that he is injured internally. He is taken to a hospital, and there may be brought a suit for damages. Very often there is. Is the man seriously injured or is he not? That is the question I expect the surgeon to answer. You see at once how the legal and surgical departments come immediately into touch. I say to Dr. Outten, there is Mr. So-and-So, who is in the hospital; he has been under your treatment all this time; you know everything about him from beginning to end, or the surgeon does who is in charge under you. Tell me whether this man is injured seriously or not. You see, I am bound to depend entirely upon the judgment of these surgeons. I do not know whether the man is simulating an injury or not. You know that sometimes spinal shock is the result of real or pretended injuries received on a railroad. A man may pretend that he is permanently injured without having any external wound upon his person. He may pretend that he has received an injury to the spine, which has resulted in paralysis, which has confined him to bed, and many dollars have we paid out upon the spinal shock theory. As a matter of course, if you take a man, put him in a hospital, and he has been under the intelligent supervision and care of these men who are honest and want to take no advantage of him, then, don't you see, I can confer with Dr. Outten, who may say: "Well, Mr. Cochran, that man is badly hurt." If that is so, Mr. Jones and the general clain agent can meet together with Dr. Outten, and we can all talk the matter over, and the result usually is we settle with the man on a basis commensurate with the extent of the injury he has actually received.

If, on the other hand, the doctor says that this man has no evidence at all of this injury, that he has examined him carefully, and that there is nothing serious the matter with him, we know how to proceed with the adjustment of the case, and we are willing to pay him a small amount, perhaps, and let him go. If an employe is partially disabled and cannot pursue the work he has been formerly doing, we are likely to give him some position upon the railroad where the work is not too hard, particularly if he has been a faithful servant. We put such men in positions as watchmen, gatemen or something of that kind, so that they may earn their daily bread. Our officers have endeavored, and I presume always will endeavor, to cultivate the kindest and best feelings with the employes, and in conducting such a large railway service it is essential to have the acquaintanceship and friendship of all. The hospital department is not only a very benign institution for the men, but it affords an opportunity for close communication between the legal and the hospital departments.

Again, we very often ask our medical and surgical departments to advise us in reference to an injured employe or passenger where there is a suit brought and there is going to be a fight in court. There may be a number of doctors to represent the plaintiff, and who, perhaps, will

Gen

go on the witness-stand and testify that the injury received is a very severe one, and while I am not a member of your association, I am called sometimes to act as a sort of doctor and lawyer combined. Of course, I do not know as much as some of you do about the nature and treatment of wounds (laughter), and whether they are likely to prove permanent or not, and I call in the representatives of the surgical department to tell me the extent of a wound or wounds, and it is simply marvelous what an advantage we all gain by our close, friendly asso ciation with the surgical department of the railroad in the preparation of our cases. Our surgeons and physicians sit down with us, and we enter into all the details. erally it is the trial lawyer, not myself, who does this, one of my attorneys who is in charge of the particular case. The doctors sit by his side in the courtroom; they hear the testimony of the other doctors, sometimes very reputable men, and sometimes, I am sorry to say, they are not so reputable. But here are these well-known surgeons, because we all try to have the best, and not to have anybody connected with our railway system except those who are really well known and are a credit as surgeons. These men, as I have previously said, sit right beside the lawyer and tell him this is so-and-so, and that such-and-such a statement is incorrect because of so-and-so, etc. In this way we are able to defeat a multitude of cases. But were it not for the signal services rendered by our surgeons, we would be perfectly helpless in many instances.

Now, it seems to me, that, generally speaking, there is not that close and friendly feeling existing between the legal and medical departments of railroads that there ought to be. I think that the doctors are prone to say: "Oh, well, we have our business to attend to; we can't be bothered in going around to lawyers' offices and conferring with them." And I think in the case of the lawyer he is apt to say: "I am crowded and burdened with business, and I don't want to be bothered with the doctors." But I tell you, gentlemen, it is an absolute necessity if a railroad is going to be conducted economically, sensibly, honestly, in dealing with the outside world and with our employes and with everybody. The railroad must be operated for its best interest, and there must be a community of interest between all of the departments. You cannot separate them. This arm of mine is necessary to my body; I cannot very well do without it; I might get along in some sort of way without it, but I am crippled if I do not have it. This leg of mine is needed to walk upon. Take it away, and, of course, I have my head and my body, and my other leg, and two arms, but I am moving along on crutches, a cripple, for want of that leg. So it is a great railroad corporation to-day is a great body, with its head, its arms, its legs, etc., and you cannot take away one of these departments without making your corporation a cripple in a certain sense. It may be a finger only, or a little department, and so you say: "I will do without that," and the finger goes. That is not so bad as a leg, but nevertheless it is a finger gone.

I repeat, there must be a community of interest between every department of a railroad and of every other department, and I believe the one great success of the magnificent system of roads with which I have the honor to be connected is due largely to the fact that there is