least well written and the directions given seem too condensed for usefulness. The second half treats of the different zymotic diseases and their specific microbes. The chapter on suppuration is especially full and clear. That on tuberculosis is at times so vivid as to be even dramatic, especially when he describes the entrance of the bacillus, its arrest by the leucocyte which "drags it off to some other region in whose narrow passages a most hostile strife doubtless takes place." He considers the true place of tuberculin to be as a diagnostic agent valuable in veterinary practice but dangerous in human medicine, except in cases of lupus or other external forms where destroyed tissues can be readily discharged from the surface of the body. A short though serviceable index completes a work admirably adapted for the purpose intended, that is, a working manual for the student and practitioner. While not an exhaustive treatise like that of Sternberg, yet it is of convenient size and moderate in price, although far from being one of those pernicious foes of true education, a quiz compend. It occupies a medium ground, serving the latest on bacteriology in a form palatable, digestible and nutritious. The publisher's part is also well done; the paper is good, the binding neat, the letterpress comfortable and the illustrations plain and abundant. H. F. L. Wounds of the Thorax. M. Quénu, in reporting two cases of penetrating wounds of the thorax to the Société de Chirugie, remarked that in one of them the intercostal artery had not been wounded, though the loss of blood had been great and the effusion so considerable as to render operation necessary. The seventh rib having been resected, the pleura was incised and the lung found to be retracted, except in the lower portion, where it was adherent to the parietal pleura, some blood-clots, which were here, being removed. The cavity was filled with iodoform gauze, which, when removed several days later, was found to be scarcely tinged with blood; the patient left the hospital cured within fifteen days. Quénu believes that in cases of hemorrhage following traumatism, which, however, may be followed by recovery without incision, such intervention should be practiced more frequently than it is, being free from danger and favoring retraction of the lung. It is naturally more strongly indicated when the hemorrhage is persistent. M. Berger said that the hemorrhage in such cases could often be arrested by tampons. M. Delorme believed it best to wait and see if the hemorrhage were not spontaneously arrested before operating or until symptoms of infection became evident.-Bull. Med. Miscellany. A New Discovery Concerning Alcohol. The antidotal effect of alcohol in carbolic acid poisoning is recorded in The Medical Record by Doctor Donald B. Fraser of Stratford, Ontario. A woman had resolved to employ carbolic acid as means of self-destruction, and began casting about for a vehicle that would obviate pain. She first mixed the acid in beer, and cautiously drank a small quantity, suffering but little pain or burning sensation. She then experimented with the acid in whisky, and felt less pain or burning. The suicidal drink consisted of half-and-half. Fifteen minutes after its ingestion the woman was in a condition of profound stupor, with the pupils contracted to pin-points. No staining or other evidence of the corrosive action of carbolic acid appeared on the lips. tongue or about the mouth or throat, but an empty bottle, labeled carbolic acid, told the story. Four hours after swallowing the poison the pulse was strong, regular, not much accelerated; the respiration was undisturbed: the temperature was slightly under 98 degrees Fahrenheit; the arms and legs indulged in occasional jerking, but no sensation was elicited on pricking the fingers or toes. Eight hours after taking the poison the patient recovered consciousness and told what she had used, adding that she felt only slight pain or burning sensation, and had experienced pleasant dreams. Vomiting now ensued and continued almost uninterruptedly for twenty-four hours, when it suddenly ceased and convalescence was rapid. If a mixture of equal parts of carbolic acid and alcohol be poured over the back of the hand, scarcely a trace of corrosive action will be apparent if the applied surface be promptly washed off with alcohol. The white stain caused by the liquid carbolic acid can be removed by the immediate continued application of alcohol. If a pad be saturated with alcohol and applied to a carbolic acid burn the pain will be relieved and the stain removed until heat is felt in the pad, when both pain and stain return. This phenomenon will continue as long as heat develops in the pad, and will cease when heat is no longer evolved, therefore continue changing the pads. until the desired effect is produced. The symptoms in this case were somewhat akin to those produced in opium poisoning. The diagnostic feature was the quiet and regular breathing. Aside from its antidotal properties, alcohol acts as a stimulant to combat the intense depression usually experienced in carbolic acid poisoning.-Physician and Surgeon. Privileged Communications. The Court of Appeals, in the case of Mary A. Morris against the New York, Ontario & Western Railroad has rendered an interesting decision bearing directly on the question of privileged communications. Section 834 of the Code of Civil Procedure says: "A person duly authorized to practice physic or surgery shall not be allowed to disclose any information which he acquired in attending a patient in a professional capacity, and which was necessary to enable him to act in that capacity." Mrs. Morris, in the case decided, sued the railroad company for injuries received. At the time of her illness she was attended by two physicians. The second, being called into consultation, was present, and assisted in an examination which was made for the purpose of ascertaining whether or not her spine had been injured. When her suit against the railroad company was tried she called one of the doctors to testify for her, but did not call the other. The railroad company, in its defense, called the second physician and asked for his opinion of the injuries. The questions were objected to by the lawyers for Mrs. Morris on the ground that to answer them would be a violation of Section 834 of the Code. The General Term sustained the objection, and excluded the testimony. Mrs. Morris won her case, and the railroad company appealed to the Court of Appeals. The decision was written by Judge O'Brien and concurred in by all the Court. It was that by calling one of the physicians Mrs. Morris expressly waived the privilege of secrecy. The decision says in part: "We think that a construction of the statute which permits a patient who has been attended by two physicans at the same examination or consulation to call one of them as a witness to prove what took place or what he learned, thus making public the whole interview, and still retain the right to object to the other, is unreasonable and unjust, and should not be followed. The waiver is complete as to that consultation when one of them is used as a witness. The considerations and reasons upon which the statute was founded no longer exist when full disclosure is made by either with the consent of the patient and every party to the transaction thus disclosed is relieved from any injunction of secrecy. The patient cannot limit the scope or effect of the waiver when made, any more than she can recall it. When the plaintiff in this case called one of the physicians, who disclosed the whole consultation, the law determined the legal effect of that act, irrespective of any mental reservations on her part. Upon every principle of reason and justice this act amounted to a waiver of the right to object to the testimony of the other physician when called by the defendant as to the same transaction. For these reasons we think the testimony excluded was admissible, and that the judgment must be reversed and a new trial granted, costs to abide the event."-New York Sun. About Transportation. Members of the National Association of Railway Surgeons wishing to attend the annual convention at St. Louis should apply for transportation to their respective managements, and ask them to procure transportation from connecting lines. FOR SALE. PRACTICE FOR SALE:-I offer for sale my practice in the county seat of one of the best counties in Iowa. Have been here for twelve years; am surgeon of the leading road entering the town; am medical examiner for six life insurance companies, etc. I simply require that my successor buy my office fixtures, mostly new-worth $700. Purchaser must be reliable physician with few years' practice. Address "Z. V.," care RAILWAY SURGEON, Chicago. Desiring to remove to the Pacific Coast, I offer my well-established practice of over 20 years to any physician who will purchase my real estate, situated in one of the most beautiful and thriving towns in Southern Michigan, and surrounded by a very rich farming country. The town is intersected by two important railroads, for one of which the subscriber is surgeon. The real estate consists of a fine brick house of eight rooms and two fine offices besides, attached to, and a part of, the residence. A fine well of the purest water, two cisterns, waterworks, etc. Fine garden filled with choice fruit in bearing, peaches, pears and apricots and small fruits, raspberries, currants, etc. Fine barn and other outbuildings, comparatively new and in the very best condition, all offered with the practice and goodwill at a very low figure for cash. Address "MACK, Surgeon," care RAILWAY SURGEON, Monadnock Block Chicago, Ill. By reason of failing health, physician wishes to dispose of real estate and practice. Practice amounts to nearly $4.000 per year. No charges except for real estate. Address WM. D. B. AINEY, Montrose, Pa. Desiring to remove to a warmer climate, owing to poor health. I offer my well-established practice of 11 years to any physician who will purchase my real estate: situated in one of the most thriving towns in the Platte Valley, in Central Nebraska, on main line of Union Pacific R. R., on which road I am the assistant surgeon. The real estate consists of 2 lots "on corner," on which there is a fine artistic "modern" frame house, 8 rooms; stable 20x30, wind mill. tower and 30-barrel tank: nice blue grass lawn. trees and fine garden (all new): and all offered with my $5,000 practice and good will, at a very low figure. A part cash, balance on time. A very thickly populated country. Address BOVINE," care RAILWAY SURGEON, Monadnock Block, Chicago, Ill .ARTHUR D. BEVAN, Chicago, Ill. .GEO. F. BEASLY, Lafayette, Ind. Fourth Vice-President....H. LOGAN, The Dalles, Ore. Fifth Vice-President.. GEO. GRAVES, Herkimer, N. Y. Sixth Vice-President. P. F. VASTERLING, St. Louis, Mo. D. EMMETT WELSH,Gr'd Rpds, Mich. Assistant Secretary. .S. R. WOOSTER, Grand Rapids, Mich. Treasurer. Executive Committee:-A. J. MULLEN, JR., Michigan City, Ind.; C. D. EVANS, Columbus, Neb.; F. H. PECK, Clinton, N. Y.; A. A. THOMPSON, Waxahachie, Tex.; S. S. THORN, Toledo, BY DR. W. C. JONES, WALNUT SPRINGS, There is certainly no more common class the railway surgeon than sprains. There is certainly no class of injuries treated with more indifference by the patients and the laiety, ject we think that some general definition and the dangers consequent on the more se- vere sprains should be given. Sprains are defined to be almost all inju- ries of joints that are not attended by per- manent displacement of the articular sur- faces. The extent of injury to the structures involved is very variable. In many instançes there is only a spot of extravasated blood the skin are filled with it. Sometimes it is uncertain whether there is a rent or not; or the strongest ligaments in the body, such as the internal lateral ligament of the knee or ankle, may be torn in two. Nearly always when this happens they drag away with them a thin scale from off the bone. In severe cases the muscles always suffer, and some- times they are extensively lacerated, possibly in the sudden spasmodic effort at recovery; the tendon sheaths are bruised and filled with blood; the nerves are stretched and torn, and even at times the bones show deep ecchymo- sis in their cancellous substance. In fractures involving joints the condition. *Read at the third annual meeting of the Texas Association of of affairs just described must be present, varying, of course, with the cause of the fracture. As showing the dangers, present and remote, of severe sprains, a few of the most severe are here described, commencing with sprains of the back. These are very common, especially in the flexible parts, the cervical and lumbar regions; sometimes they are chiefly muscular, as in cases of overwork -lifting heavy weights, for example, or in sudden awkward twists; sometimes, when due to external violence, they involve the fibrous textures, the ligaments, the fasciæ and synovial membranes as well, the muscles either being caught unawares by the unexpected jerk or being overpowered. The greater sprains occur in railway collisions, when without warning and before a single muscle can contract, the contract, the body is wrenched and twisted, or thrown with great force from one side of the car to the other, until every muscle or ligament that has an attachment to the spine is strained or hurt. The spinal cord itself escapes more frequently than might be expected; it lies in the central axis, so that in all movements it occupies neutral ground; it is separated by some distance from the walls; it has around it a water bed which is probably always filled with fluid, and in the lumbar region, where the range of movement is as great, perhaps greater than anywhere else, its place is taken by the cauda equina. The extent of injury in these cases is very variable. No structure is always exempt, but probably the muscles and fibrous tissue are the greatest sufferers. The former may be thrown into a state of cramp, they may be torn or wrenched away from the bone; there may be hemorrhage into the sheath that invests them; this may be torn and the muscular substance forced through the rent like a hernia; or, especially in the neck, where the long slender slips lie closely packed together side by side, there may be a real dislocation. The latter may be still more damaged; the broad sheets that extend on either side of the spine may be overstretched, or the loose cellular tissue that fills up the irregular spaces around and between the bones crushed or bruised; or, what is much more serious, some of the ligaments that connect the vertebræ may be strained until they yield. This is especially dangerous, not only from the proximity of the membranes and the cord and the risk of their being injured at the same time, but from the danger of hemorrhage and inflammation. A certain amount of extravasation must always occur, causing an ill-defined swelling. and tenderness, and giving rise to pain and inconvenience when any attempt at movement is made; but if the posterior ligaments, especially the ligamenta subflava, are torn, the bleeding may be severe, owing to the size of the veins that surround them, and the blood may pour down the spinal canal. In other cases the spinal nerves are hurt, stretched possibly as they pass out through the foramina, or compressed by extravasation, so that the effects are referred to distant parts of the body. Even the bones and joints do not escape, for, though it is rarely possible to prove the existence of definite injury at the time, it is certain that inflammation may break out in them afterward. The complications that follow these injuries vary with the state of the patient's health. Stiff neck, lumbago and chronic rheumatism occur in some, especially if a rheumatic diathesis be present, and this is worse after middle life; synovitis and osteoarthritis, leaving the spine rigid, ankylosed and perhaps distorted, occur in others; caries is exceedingly common, especially in children and young adults, and what is still more serious, if the ligaments have been torn and hemorrhage has taken place in the vertebral canal, inflammation of the membranes or of the cord itself may follow. In some cases this is very insidious, softening supervenes slowly and steadily grows from bad to worse; in a few rare cases it is acute, suppuration commencing externally in the broken-down blood clots, or in the joints, and spreading through a rent in the membranes, or along the lymphatics until the dura matral sheath is involved. Hæmaturia is not an uncommon complication, or rather a symptom, after sprains of the lumbar regions, showing that the substance of the kidney has been affected by the cause of the injury, along with other structures in this region. It is seldom serious, but cases are on record where it has proved fatal, probably from one of the large arteries having given way. Strange to say, swelling is not common in accidents of this kind, unless there is con " siderable extravasation. This may follow the outline of the muscles as in the neck, or simply form a smooth, rounded elevation. The skin is often very tender, but as a rule firm pressure gives relief. Redness is hardly ever present, and it rarely happens that the temperature is above normal. Sprains of the back have acquired a singular importance from their frequency in railway collisions, and attempts have been made to distinguish them when they occur under these circumstances, from others. Except, however, for their severity and for the reason that they are always associated with very grave degree of shock, which is certainly not without influence upon the subsequent progress of the case, there is no occasion for such a differentiation. Under the head of definition of sprains, in this article is given all the pathological changes that take place in whatever joint that may be affected. It is not, therefore, necessary to go into a detailed description of the changes that occur in the most serious sprains of the extremities. In the foregoing remarks I have endeavored to show that a sprain may be a trivial, serious or even a fatal injury, just as fractures may be. It is unnecessary for me to attempt a description of fractures, as this subject is discussed in some or all of its phases in almost every surgical association--even volumes have been written, and that, too, by the brightest minds that have ever graced surgical literature. Not so with sprains; I have never seen a volume written on sprains nor heard the subject discussed in a medical association, yet it must be an admitted fact that sprains, when severe, often tax the ingenuity of the surgeon as to the proper diagnosis, prognosis and treatment of the injury. Sprains, when complicated with fractures into a joint, necessarily increase the danger to both, and often render it difficult to say which injury will be the first to recover on account of the intimate relations of the structure and the mutual dependence of both. My observation and experience on sprains as compared with fractures has led me to the conclusion that a serious sprain of the more important joints, such as the ankle, knee, hip or back, is more painful and oftentimes more obscure as to the course it will take, longer in regaining its normal function and useful ness than fractures of the shaft of the tibia or fibula, or even of the thigh, whether the fracture be simple or complicate Many cases corroborative of the above conclusion might be given; for instance, I know a farmer who was thrown from his wagon more than ten years ago and sprained his neck, who is still a sufferer from that cause. I know a bridge carpenter, who, while pumping a handcar, with his back turned in the direction the hand car was going, fell in front of it, face up, the body was rolled upon itself by the motion of the car, producing sprain of the back, followed by hæmaturia, which confined him to the Texas Central hospital for five weeks, when he was able to travel about, but who is not able to do manual labor, now five years since the accident. I know an engineer, apprehending a wreck, swung himself out of the cab of his engine, alighting only a short distance from his engine; he sprained his knee, which confined him to his bed four weeks, and he still limps, the accident having occurred more than six years ago. As to sprained ankles, when they are severe, they are correspondingly slow in their permanent recovery and usefulness. The symptomatology and treatment of sprains and fractures have been omitted, as there is no line of comparison of these injuries that could be appropriate for this article. REPORT OF A CASE OF PERIOSTEAL REPRODUCTION OF BONE.* BY DR. A. BAILEY, RICHMOND, VA. I hope the following case may be of some interest. I will not enter into a discussion about resection or excision and the possibilities of reproduction of bone by the periosteum. We have been taught for some years that a seçtion of bone may be removed and if the periosteum be left intact the continuity of the bone will be restored. I read an article, however, in The Railway Surgeon which, it seems, endeavored to disprove this doctrine. My case is evidence. in point to sustain the doctrine. About the 19th of March I received a note from Dr. Rich asking me to come seven miles in the bottom prepared to amputate. Upon arrival I found Lige G., a negro, suffering from *Read at the third annual meeting of the Texas Association of Railway Surgeons, at Houston, Tex., Jan. 21-22, 1896. |