Department of Railway Surgery.

GEO. CHAFFEE, M.D., Editor.

226 47TH ST., BROOKLYN, N. Y.

OFFICIAL ORGAN

N. Y. STATE ASSOCIATION OF RAILWAY SURGEONS. ERIE RAILWAY SURGEONS' ASSOCIATION. FLORIDA STATE ASSOCIATION RAILWAY SURGEONS. PLANT SYSTEM RAILWAY SURGICAL ASSOC'N. THE ASSOC'N OF SURGEONS OF THE SOUTHERN RAILWAY CO.

EDITORIAL.

SELECTION OF SKILLED SURGEONS DISCHARGES EVERY OBLIGATION.

We trust that they are few, but if there can be found any railway surgeons who are still allowing themselves to believe that railway corporations are anxious to become responsible for the mistakes of their surgeons, it is our opinion that they will sooner or later be called upon to attend a big surprise party. Where the surgical department is properly organized and working in harmony with the other departments, an element of loyalty exists between company, surgeon and employee, which is mutual. If any of our surgeons have allowed themselves to fall so far behind the times and have also fallen a victim to this easy but erroneous theory of responsibility, they should at once set about, or stay up all night, if necessary, and begin to reform and also to inform themselves upon the duties, qualifications and responsibilities of the railway surgeon. The position is high, and one requiring, at all times, our very best talents. Our comments are prompted by a quotation from the Columbus Medical Journal, which gives the ruling in a case from the Supreme Court of Tennessee:

"The Supreme Court of Tennessee puts itself in line with the few courts which have before it passed upon the same question, by holding, in the case of Quinn vs. Kansas City M. & B. R. Co., May 2, 1895, that, having selected surgeons skilled and competent in their profession, a railway corporation discharges every duty that humanity or sound morals impose, and that it is in no way liable for the mistakes they may subsequently commit."

There is but one way of doing surgery and that is the correct way. Surgeons, take time; do your work well, do it right; in operating pay strict attention to detail, and never allow a case to pass from your service until you have finished with it.

The surgeon who has back of him a high purpose and a principle, will find much comfort in such practice, realizing, as he must, that the surgeon only makes the operation, but he must make it right, and God does the rest, or works the cure through nature.

NEW YORK STATE ASSOCIATION OF RAILWAY SURGEONS.

The sixth annual meeting of this Association was held at the Academy of Medicine November 17th. The meeting was one of the most successful in the history of the Association. Dr. C. S. Parkhill presided with his usual dignity and grace, the time limit being observed on papers and discussions which proved satisfactory to all. The papers presented covered the domain of railway surgery fairly well; but the papers of the day were: "Injuries to the Head," by Dr. Roswell Park, of Buffalo, and "Relief and Hospital Department," by Dr. Frank H. Caldwell, of the Plant System. At the executive session a resolution was unanimously adopted which placed the New York State Association of Railway Surgeons on record as favoring the Relief and Hospital Department.

Hon. Chauncey M. Depew, Hon. Cornelius Vanderbilt, Hon. John M. Toucey, Rev. W. A. Dixon, of Brooklyn, Dr. Roswell Park, of Buffalo, and Dr. S. C. Graves, of Grand Rapids, Mich., were elected to houorary membership.

In the evening a banquet was given at the St. Cloud Hotel, in honor of the invited guests, which was well attended and enjoyed by all.

The officers elected are: President, Dr. J. Frank Valentine, Richmond Hill, L. I.; First Vice-President, Dr. Geo. Graves, of Herkimer; Second Vice-President, Dr. F. H. Peck, of Utica. Dr. C B. Herrick, of Troy. was re-elected Secretary, and Dr. T. D. Mills, of Middletown, was re-elected Treasurer.

CHIEF SURGEONS.

Dr. G. P. Conn, of Concord, N. H., was born January 25, 1832, in Hillsborough, N. H. Until sixteen years of age he lived upon his father's farm, attending the country schools and doing farm work. After this he was a student for a few months at the Francestown and the Pembroke Academies, and spent two years at Captain Alden Partridge's Military Institute, at Norwich, Vt. Beginning in 1852, and until 1856, he read medicine in the office of Dr. H. B. Brown, Hartford, Vt., in the meantime being instructor in mathematics at the academy in that town; attended two courses of lectures at the Vermont Medical College, Woodstock, and one course at Dartmouth Medical College, Hanover, N. H., receiving the degree of M.D., from the latter institution, November 12, 1855. In 1880, the honorary degree of A. M. was conferred upon him by Norwich University.

Dr. Conn was commissioned assistant surgeon of the Twelfth Regiment, Vermont Volunteers, Aug. 19, 1862, and in connection with the late Surgeon Phelps,

Medical Society and Vermont State Medical Society; is a member of the various Masonic Associations, and of E. E. Sturtevant Post, Grand Army of the Republic. He was a member of the Board of Railroad Commissioners of New Hampshire, 1877, 1881, being twice elected by the popular vote of the State, and has been a Chief Surgeon to the Boston and Maine Railway since 1880. Member and Vice-President National Association Railway Surgeons, honorary member New York State Association Railway Surgeons, and was elected to fill the Chair of Hygiene at Dartmouth Medical College, in 1894.

DR. G. P. CONN.

far as can be learned, the first in this country. He was largely instrumental in securing the passage of the act by the State Legislature in 1881, creating a State Board of Health, and has been a member of the Board and its President continuously since its organization.

While a resident of Vermont, Dr. Conn became a member of the Vermont State Medical Society, and has since been made an honorary member of that Society; became a member of the New Hampshire State Medical Society, in 1865, of which he has been Secretary since 1869, except during the years 1880 and 1881, when he was Vice-President and President, respectively; is a member of the Centre District Medical Society, American Medical Association, American Public Health Association, Vice-President in 1895, and Chairman of the Section on Car Sanitation; member of New York Medico-Legal Society,

DR. CHARLES K. COLE

Charles K. Cole, Helena, Montana, was born April 5, 1852, at Plainfield, Illinois. Early left to depend on his own resources, he developed a spirit of perseverence which has continued with him through life. He graduated from Lincoln University, Illinois, in 1872. He read m dicine under Dr. David Prince, of Jacksonville, Illinois. Later he attended the Miami Medical College, of Cincinnati, Ohio, graduating from there in 1879, and he has annually availed himself of opportunities for study in the hospitals of New York, Chicago, Berlin, Vienna, Paris and London.

Dr. Cole first located in Jacksonville, Illinois, but impelled by the desire to be in a larger field, he moved to Helena, Montana, in 1880.

He is a Fellow of the American Surgical Association, member of the American Medical Association, member of the Medico-Legal Society of New York, an honorary member of the New York State Association of Railway Surgeons, member of the National Association of Railway Surgeons, member of the Medical Association of Montana (President in 1884), President of the Board of Medical Examiners of Montana, ExPresident of the American Academy of Railway Surgeons, Surgeon to St. Johns Hospital since 1880, to St. Peter's since 1882, Chief Surgeon to the Montana Central Railway, and has recently been made a delegate to Mexico as a representative of the medical profession from Montana to the Pan-American Medical Congress. In 1889 he filled acceptably the position of President of the State Senate of Montana, President of the City Council of Helena in 1884, President of the Chamber of Commerce of Helena in 1887, VicePresident and Director of the Second National Bank of Helena 1883-1894, President of the Montana Hydraulic Mining Company, and in 1894 was chosen by the Montana Legislature as one of the five Commissioners in the construction of a million dollar capitol building.

Dr. Cole's contributions to medical literature are numerous and valuable.

THE ASSOCIATION OF ERIE RAILWAY SURGEONS.*

BY JOHN L. EDDY, M.D., Olean, N. Y.

The Association of Erie Railway Surgeons has grown to such a powerful and prosperous organization that it may not be amiss for us to pause and take a retrospect of the past and trace our existence backward to its beginning, and owing to its short span of life this is not a difficult task, and it aptly illustrates the old proverb that "Great oaks from little acorns grow."

Some time in the summer of 1891, my friend, Dr. S. Birdsall, of Susquehanna, Pa., invited a number of the Erie surgeons to be present at the State Association which was to assemble October 27, 1891, at Bensonhurst-by-the-Sea, and discuss the advisability of organizing or forming an association of Erie surgeons. Only a few of the Erie surgeons were present at that meeting, but enough interest was manifested at the time to inspire them with the hope of ultimate success, and consequently they adjourned to meet in

* President's address, delivered at the annual meeting held at Lakewood, N. Y., Sept. 21, 1896.

Elmira, Jan. 12, 1892. And at this meeting twentytwo surgeons assembled and completed the organization. We now have a large membership, and I am happy in being able to say to you what has been said to me several times during the past eighteen 'months by western surgeons: "That the Association of Erie Railway Surgeons is the best, has the most talent and surgical ability of any individual railroad organization." In each instance the compliment was voluntary and I know they meant what they said. As co-laborers we are all interested and share in this praise, and feel a just pride in laboring to maintain the high character and standing to which our organization has been raised in the short space of a little over four years.

And now I will call your attention to our Constitution and By-Laws. It seems to me they are inadequate to our present needs. I find on the outside cover. last page, that we have a committee of three members, but a careful perusal of the by-laws gives no idea of the nature of their duties. I would recommend that this committee be designated as Executive Committee and their duties defined as to locations of the annual meetings, also transportation. There are good and sufficient reasons why a committee can handle the location better than the entire body. There are also other duties naturally belonging to the committee. The location of the present members, and their previous service in this line of work, make them desirable members of the committee.

Necrology.-I would also recommend the appointment of a committee on necrology consisting of two members, one from the eastern, the other from the western division; located centrally on those divisions, so that in the case of death of one of our members suitable mortuary notice should be transmitted to our official journal without waiting for the annual assembly to direct the same, and said committee should have prepared a suitable memorial and present the same at our annual meeting, to be written on a page set aside for that purpose. And to the all-wise Father, who holds our lives in the hollow of his hands, we offer our heartfelt thanks that the cruel messenger of death has summoned none of our band the past year. and I am not aware that any of our members have died since our organization, except Dr. Hall, of Jamestown.

Program. I would also recommend a committee on program of two members, permanent, one from the eastern and one from the western division, whose duties are indicated by the title of the committee. I believe a permanent committee can handle this question a great deal easier than a new president can. I realize more fully than I ever did before, the hard work a president has every year to arrange the program, and

get a sufficient number of papers, not too many. The late Henry Ward Beecher once said: "One good sermon was enough for any man to digest, and two poor ones were too much for any man to listen to." At our last annual meeting I arranged with Vice-President Kelly to furnish, from the western division, seven or eight papers for this meeting. In the early part of the summer I wrote reminding him of the arrangement previously entered into, asking him as soon as he could to furnish me with the title of papers and the authors who were to read them. I waited until some time in the forepart of August, and then wrote him, saying I presumed he had them already prepared and asked to have them forwarded as soon as possible, so I could arrange the program. On the 29th of August, I left for St. Paul and Minneapolis. On my return, September 7th, I found a letter on my desk, dated August 28th, from Vice-President Kelly, saying he was just recovering from a siege of acute rheumatism and had been unable to do anything. Of course, this was cause sufficient to excuse him, but it left me short of papers on short time. He kindly gave me the names of four surgeons in his district to whom he wished me to write for papers. The notice was rather short, but I immediately followed his suggestion, and only one, Dr. Kinnaman, gave any reply.

I

In the early summer I sent out some twelve or thirteen letters to different surgeons asking for papers, with only two favorable responses: Dr. Harnden was the first to respond, and those of you who had had any correspondence with him know what pleasant letters he always writes. Dr. Birdsall was the second to respond. Some gave sufficient reasons to be excused, and the others I think have not yet decided upon the subject they wish to write about, and are still pondering upon the theme, as they have never in any manner responded to the letters sent them. I presume the above is a fair sample of the way my predecessors in office have faired. Now gentlemen, have entered into this subject more fully perhaps than was necessary. I have done so because I believe it to be of great importance to the association to have such a permanent committee, for I know full well the trials a president has to encounter, and so does every ex-president of this society, and a permanent committee would always know the labors before them and would be prepared for emergencies. I would, therefore, recommend the appointment of a committee of three to revise and complete our by-laws and report the same to this association for adoption. Since writing the above a letter of regret was received from Dr. T. W. Thomas, Marion, Ohio:

Gentlemen:-You are well aware of the contracts between the Association and the INTERNATIONAL JOURNAL OF SURGERY. In consideration of your

adoption of the JOURNAL as your official organ they were to put the price of the JOURNAL at one dollar, provided you all subscribed for and became patrons of the JOURNAL; they were also to provide at their expense, a stenographer to take down the proceedings and furnish a certain number of reprints of each paper read. Now I am creditably informed that only a small proportion of the members of this Association are subscribers, and you have by your tardiness and non-support forfeited your contract. Not enough money has been received to pay the expense of the stenographer. I would recommend that the annual dues be increased to two dollars, except to such members of this Association who hold membership in the State Association, and those whose receipts paid in advance may be credited the amount of their receipts

on the annual dues.

Some means should be devised to compel a larger a tendance of the members at these gatherings. I think when the time is opportune, a hint from the chief surgeon that they would be expected to attend the annual meetings or render a sufficient written excuse would have a salutary effect.

TUBERCULAR NECROSIS OF BONE.

BY J. D. ZWETCH, M.D., Gowanda, N. Y. Appreciating that my subject is one that does not come in the line of railway surgery, yet on account of the early appearances frequently presented which simulate certain degrees of traumatism, but where claims might be made that the conditions were the result of railway injuries, I venture to place before this society a history of three cases that have come under my care, without, however, entering into the study of the pathological conditions presented by them.

I was called in November, 1893 to see Mrs. F. T., aged forty-four. She had been ill about four years. The first indication noted was a chill and severe pain in the left knee. Different physicians treated her for a time and the pain ceased at the knee and went to the ankle which became swollen and produced considerable suffering for another year. A sinus then appeared which discharged freely; she was treated by another physician who used carbolized injections and washes, but the wound failed to heal. Her health gradually failed for another year, at which time I was called and found the following conditions present: Patient in bed very much emaciated; temperature 102°, pulse 120; no appetite and very weak; two fistulous openings on the outer side of the ankle, the inner side being very badly swollen, and which I opened, letting out considerable pus.

*Read before the Annual Meeting of Erie Railway Surgeons Association held at Buffalo, Oct. 1, 1895.

I found the ends of the tibia, fibula and astragalus very badly necrosed. There also appeared a diseased condition of the knuckle joint of the left index finger with a fistulous opening. My diagnosis was tubercular necrosis. I failed to mention that she, to all appearances, passed the menopause at thirty-five years, but previous to that time the menses had been very free, all the conditions of ill health following after the cessation.

I began to build her up preparatory to an operation, opening up and evacuating all the pus, which relieved the pain. I gave her cod liver oil, also malt extract, using care to keep the bowels free and the ankle wound as aseptic as possible. She gained about ten pounds in six weeks; temperature lowered to nearly the normal point; pulse 90; appetite good. Consider. ing the fact that she was doing so well, I concluded to wait a little longer before operating. I saw her in a week from that time, but she seemed to have reached the limit of strength and showed signs of breaking down again, when I decided to operate at once. With competent assistants I began with the idea of performing an exsection of the ankle, making an Lincision. I found the tarsal and metatarsal bones in a condition of softening to the extent that I could readily push the knife directly through the bones, and after consultation decided to amputate the leg midway between the knee and ankle, where I found the medullary canal of the tibia and fibula filled with pus which extended to the upper extremity of the bones. My patient then being so weak and also suffering from severe shock, I dared not amputate higher up at the time, so cleaned out the pus and curetted the canals, completing the operations as rapidly as possible, which, however, was somewhat delayed on account of the husband objecting to the operation until after an exhaustive explanation.

At the conclusion of the operation the pulse was 140, surface of the body cold; and I might mention that I had considerable trouble with hemorrhage from the medullary canal which was however controlled by elevating the limb. I gave her three hypodermic injections of strychnia of a grain each, between 4 and 12 o'clock P. M., but with no apparent improvement. I then resorted to frequent hypodermic injections of brandy and digitalis, and within twenty minutes after each injection I could see the effect on the pulse, and at 4 A.M., she began to rally, progressing without any bad symptoms afterwards. She was able to sit up in three weeks and had gained twenty pounds in flesh in the next three months; general conditions normal.

The leg, however, would not heal, and as she was living some distance from me, I had her brought where I could see her every day. I operated upon the

hand, removing the dead bone from the joint which healed kindly, and also made an opening into the stump of the leg and found the bones badly necrosed. On the 28th day of June, I started an operation with the idea of amputating at the knee joint, but after opening the joint found it so diseased that I decided to amputate at the middle third of the thigh. I found the medullary canal of the femur dark colored and unhealthy in appearance. I scraped out the marrow up to the neck of the femur where I found it quite healthy; used silk ligature on the femoral and profunda arteries and catgut on the minor vessels, although it would be my judgment now that catgut is sufficiently safe for the ligation of any blood vessel.

After this operation the stump healed by primary union, except through a small sinus caused by the silk ligature, which I soon afterward drew down as far as possible, clipping it off, and the sinus promptly closed. The ligatures together with the knots upon the same were discharged about two months later. Present condition of the patient, weight 130 lbs., wears an artificial limb, is doing her own work, and to all appearance a healthy woman.

Case 2. Miss A. Smith, an Indian girl, age fourteen, inmate of Orphan Asylum, who had a tuberculous or scrofulous ankle for two years previous to the time I took charge of the asylum. She was very much emaciated and suffering severe pain, so that it materially interfered with rest at night, and all of the bones of one ankle were apparently diseased. After experience with the previous case herein noted, I proceeded at once to amputate the leg half way between the ankle and knee. The medullary canals of both bones were perfectly empty, and the curetting of the same produced no hemorrhage. I used the aseptic precautions of the day during the operation. No shock followed, and for ten days she progressed nicely. At the end of that time I noticed that the margins of the wounded stump were becoming discolored at the edges where there was a small amount of sloughing, possibly caused by too much pressure either from stitches or dressings, but which was insignificant so far as the progress of the case was concerned, as the stump readily healed. She gained 12 lbs. in two months and has been perfectly well since. She has been wearing an artificial leg for six months.

Referring back to the sloughing of the stump, I think it possibly may have been from her scrofulous condition, which I find to be well marked in her