muscles, and in a well-developed individual there is so little space there, as the gluteus maximus covers it. I also injected the anterior crural below Poupart's ligament, so that all the tissues supplied by the sciatic and anterior crural nerves were rendered anesthetic. He made very little complaint and the operation was done comfortably. When it was over he said he could stand another one perfectly well. He went out well and his condition remained perfectly satisfactory.

The case of double amputation of both legs for gangrene seemed to me to be more successful than the others. The man never moved or winced. When asked, he said it hurt some, but not much. He said it did not hurt at all to saw the bone; he knew it was being sawed, but left no pain-only the grating. The incision through the soft parts was painless. When asked what he was thinking about he said "something to eat." He did absolutely well.

I do not claim any originality for this. I got it from Crile, of Cleveland, but it seems to me to open opportunities which otherwise we would not have. Of course, we can get the same result by injecting the spinal subarachnoid space with cocain. I have done that, but do not like it. It may be all right, but the mortality is greater it is, in my opinion, dangerous. If you once get an infection there is no stopping it. The actual effect of the cocain injection into the spinal cavity is of itself, in some cases, serious. It is an operation which, whilst I have done it in several cases, I do not like. The injection of the nerves, however, is followed by no bad effect. There is no danger attached to it. You must know, of course, where the nerves are, which is not at all difficult, and which every surgeon is supposed to know. This injection can be done in the upper extremity, but the nerve distribution is so much more intricate that it would be attended with more difficulty. The incision would have to be carried into the neck, and the brachial plexus would have to be exposed. I have not done it in that locality, but suppose it could be done with equal success. It offers a means by which we can remove limbs or do other surgical work without general anesthesia. The method is applicable to the ligation of arteries, stretching of nerves, joint resections or almost anything.-Virginia Medical Semi-Monthly.

he had to cease practising his profession. His claim for damages was submitted to a court of law, which has decreed that the doctor shall receive annually from the company 17,000 marks (about $4,000).-Med. Record. CONSECUTIVE TREATMENT OF OPEN FRACTURES-WET OR DRY DRESSINGS.

BY THOMAS H. MANLEY, PH., D., M. D.

Consecutive Treatment of Open Fractures.-The primary treatment of an open fracture ends when the patient has been brought to his home or hospital, and at a time when the temporary splinting and dressings have been removed; when reaction is well established. Quite a few with open fractures receive no outside treatment, nor any special care, until they are domiciled. The same general principles, however, will obtain in these as other cases. After all serious fractures, involving profound constitutional disturbances, when there is no hemorrhage, no extreme suffering, and the circulation is intact, it certainly is prudent not to disturb the splinting or dressing until reaction is fully established. When fragments have fallen readily into place, when there are no signs of infection and no discomfort, it is well not to meddle with the primary dressings for four or five days or even a week. The mangled parts slowly recover their nutritive and regenerative activity, and hence, haste or ill-timed interference avails nothing, and may be harmful.

Wet or Dry Dressings.-When there has been extensive. laceration of the soft parts, with or without loss of the limb or appendage, the process of detachment is invariably effected by a process of gangreous ulceration. The disintegrated residue of the osseous and other deep parts is attended with a sero-purulent discharge, which is usually odorless. This process will have commenced when we receive the temporary dressings, and will continue until union of the fragments has commenced.

When the fragments and overlying tissues unite primarily without infection, this is absent. In most open fractures artificially produced, this discharge is quite invariably absent.

As the time for permanent dressings arrives, some definite line of treatment must be decided on, varying according to the complications present.

Shall we now freely flush and irrigate the wound with

JURIES.

Dr. Hubbard W. Mitchell of New York recently brought suit in the Supreme Court at Jersey City against the Jersey City, Hoboken, and Paterson Street Railway Company, claiming $50,000 damages. Dr. Mitchell was riding in one of the company's cars which was derailed and he was thrown to the floor, his head striking the seat on the opposite side. He claimed that he had been made deaf in his left ear, which had been specially trained in auscultation, and that as a result his practice, which was worth $30,000 a year, was almost ruined. The jury awarded him only $700. In marked contrast to this judgment was that rendered not long ago in the case of a Dr. Weissberger, a surgeon of Frankfort, Germany, who was so severely injured in a railroad accident that

solutions; or shall we employ wet or dry dressings?

In the very recent past, the walls of our operating rooms were lined by shelves holding vast jars of irrigating fluids. Everything was sopped and soaked with fluids. The operator stood in clogs, and was enveloped in rubber clothing.

The excessive irrigation which was thought to be an essential feature of asepsis, has been proven unnecessary and harmful.

Befouled wounds must be flushed as to clear away effete substances, but healthy wounds bedewed only by the normal secretions of the tissues do much better without frequent or large ablutions.

Healthy wounds devoid of inflammatory action tend to repair with greater facility under dry or moist dressings than the saturated or very wet.

This is important to appreciate in open fractures, in which the change of dressings often involves moving the patient, or a possible painful disturbance of the frag

ments.

Several open fractures of the leg have come under my care, in which only one dry dressing was applied until the process of osseous fusion had fixed the fragments. In open fractures produced artificially, in osteoplastic operations, one dry dressing will usualy be all required during the first ten days.

In a considerable number of cases of open fracture, acute inflammatory reaction, with augmented heat and swelling, succeed, the discharge is copious, and if from decomposing osseous detritus, it emits a foul odor. These cases call for judicious cleansing; but even here, too fre quent or too violent injecting of fluids into the open wound may retard repair by diminishing the vitalty of the tis

sues.

These are the cases, if any, which call for the employment of antiseptic solutions and dressings.

In all serious open fractures, accompanied by extensive mutilation, the vitality of all the tissues is greatly diminished; and hence, in our manipulations, cleansing, adjusting or dressings of the parts, we must be exceedingly cautious that what remains is not further enfeebled or destroyed.

It would, therefore, appear that the choice of irrigating fluids and those employed for impregnating the dressings should require some discrimination in their employment.

For the simple cleansing of a wound, sterilized water with one-fifth of one per cent of table salt is the least irritating solution.

A bona fide antiseptic solution, to maintain its claim, must be of sufficient strength to destroy pathogenic bacteria in the wound; but how this can be accomplished without at the same time working havoc with the cellular elements in the tissues, has never been demonstrated. The fact is, the wound tissue juices, lymph and serum, possess remarkable germicidad properties. Moreover, experience has proven that the solutions of the mercuric bichloride, at a strength of one to one thousand, are extremely irritating, destructive to serous membranes, and often provoke a very serious type of inflammation when applied to the periosteal, endosteal or medullary elements of bones.

My own experience with the mercuric solutions led me. to discard them early, as highly harmful fluids when employed on much shattered, split or sawn bones. The wound healed promptly, but an insidious consecutive panostitis necessitated further operating.

Except in syphilitic subjects, or in very well diluted strength, these solutions are not to be recommended in bone surgery,

If any antiseptic is believed desirable, let carbolic acid be selected, for, as yet, it remains unrivalled, both for cleansing the wound and impregnating the dressings, for it is a sedative as well as an antiseptic agent. Its peculiar and commendable qualities are: Because it is an agreeable deodorant.

I.

through absorption when this strength is employed.Medical Brief.

HYPODERMOCLYSIS.

R. C. KENT.

The writer has performed a number of experiments to estimate the rate of absorption, the specific action, and the power of decreasing renal congestion of normal saline. solution injected beneath the skin.

The following precautions are recommended in performing this operation: The fluids should flow slowly to avoid overdistention of the tissues; air should not be injected, and this may be avoided by having the fluid pass through the needle at the time it is introduced beneath the skin. The needle should be introduced obliquely and steadily. The injection should never be into muscular tissue. Edematous tissues should not be injected, but in dropsy of the organs or serous cavities hypodermoclysis may be of service in elimination. If the flow through the needle ceases, it should be pushed in slightly and then withdrawn a little, or else rotated.

The best site for the injection is the space between the crest of the ilium and the twelfth rib. It does not interfere with the dorsal position, nor cause pain through movements of the limbs or from the respiratory movements.

The writer is of the opinion that the decinormal saline solution, 0.6 per cent of sodium chloride added to distilled water that has been boiled and filtered, is the best. The quantity of the solution to be employed, as stated by Hildebrand, is one drachm of normal saline solution to one pound of body weight every fifteen minutes. This is a fair guide, but the rule should be that a liter should not be introduced in less than forty-five minutes. The rapidity of absorption is modified by existing clinical conditions. When the solution is administered under normal conditions, diuresis commences in from three to four minutes. With a rapid and feeble heart and a feeble circulation in the capillaries it is a slow method of introducing fluid, as it may remain in situ for a long time with apparently little or no absorption. Under such conditions, if enteroclysis be performed with the fluid at a temperature of 120°, the circulation is immediately stimulated and absorption occurs rapidly. Continuous hypodermoclysis is impossible, but it may be used as often as four times in twenty-four hours. In some cases repeated injections of moderate amounts promote the excretion of toxins better than the employment of a single massive injection.

Any form of fountain syringe may be employed, or even a Davidson. The reservoir of the fountain syringe should be elevated from two to six feet above the patient. according to the size of the needle employed. If a small hypodermic needle is used the syringe will have to be elevated from five to six feet. During the injection gentle peripheral massage should be carried on to promote absorption. As there is great loss of heat, which amounts to from five to fifteen degrees, while the fluid is passing through the tube and needle, the temperature of the fluid in the reservoir should be at least 110° F., which should be in creased to 115° or 120 if a fine needle is employed.

The site of the puncture and the instruments should be sterilized, and the slight pain of the puncture may be overcome by placing a drop of carbolic acid upon the skin or freezing with ethyl chloride. In the majority of cases local anesthesia is unnecessary. After the needle is removed a finger should be slipped over the site of the puncture to prevent the escape of fluid. The moisture should then be removed with aseptic gauze and a flexible collodion dressing put on.-Medicine.

SYMPTOMS OF PARESIS FOLLOWING A HEAD INJURY.

A. M. SHIELD AND T. C. SHAW.

The writers report a remarkable case in which the symptoms of general paralysis followed a head injury, and in which a trephining operation relieved the symptoms. The patient was 30 years of age, and three months before coming under observation had sustained a scalp wound in the left frontal region. There were symptoms of concussion, but he was not confined to the bed except for a short time. The bone was carefully examined and found to be uninjured. About a month after the accident the patient began to suffer from pains in the head. There was a loss of memory and a vague feeling of "not knowing what he was about." There was an alteration of character with sudden and violent outbursts of passion. The exhibition of iodides and rest in bed improved matters, but with a return to a more active life all of the symptoms recurred.

The patient was confused, apparently demented, and there was a general tremor. He complained of pressure over the scalp, and was unable to perform sustained mental work. The pupils were slightly unsymmetrical, station was impaired, the knee-jerks were present but weak; speech was tremulous, but the tongue was fairly steady. In reading he misplaced and mispronounced words and altered the spacing; the handwriting could be read with difficulty owing to the crowding of letters and the faulty up-strokes. The mental condition was one of dementia with apathy and slowness of comprehension. There was a sense of well-being. There was no history of syphilis or alcoholic excess. The temperature under the tongue was 100° F.

On reflecting a semilunar flap, including the area of the old injury, a faint crack was seen in the bone, observable only upon the closest inspection. A trephine was applied and a disk of bone removed. It was found that there was a fracture of the inner table of the skull, and the bone was crowded down upon the dura mater, which was uninjured. No pulsation could be detected. After After a further portion of bone was removed the membranes pulsated freely. Recovery was rapid and uneventful. Within a day or two of the operation there was a marked change in the patient's mental condition. became intelligent and lively, and his face assumed a bright expression quite different from the heavy, apathetic, and somewhat morose expression which it had previously worn. At the end of three weeks he was able to attend to some business, and he seemed to be quite restored. The improvement in the writing was remarkable. Before the operation he could merely make a series of barely de

He

cipherable up-and-down strokes; after it he could write clearly and well.-Medicine.

SUTURE OF THE PATELLA.

At the meeting of the Paris Society of Surgery, held on February 18, M. Quénu gave an account of some researches which he had made into ordinary methods of suture of the patella. These methods he affirmed had not much inherent strength. By using a simple apparatus he had been able to exercise traction upon sutured patellæ by means of weights.

In a patella sutured in the ordinary way a weight of 43 kilogrammes brought about a slight separation of the fragments, while a weight of 70 kilogrammes separated the fragments by one centimeter. When the broken patella was united by the wire being made to run around the fragments, 6 kilogrammes brought about a slight separation, and 20 kilogrammes a separation of one centi

meter.

M. Quénu accordingly was of opinion that flexion is at dangerous movement in a case of fractured patella, and that a patient who has fractured his patella should take the greatest care not to walk too soon, for a simple movement of flexion exerts a tractive force upon the fragments equal to a weight of 100 kilogrammes.

Finally, M. Quénu brought before the society a special method of suture of his own which he termed "transverse suture." The wire is passed through both fragments. transversely in the shape of a U. This method gives at firmer union than "cerclage," but one not so firm as the ordinary method. When the fragments are more in number than two, cr being two only one of them is very small, the wire can be passed through the tendon in either the upper or the lower fragment, thus making a hemi-cerclage;” and M. Quénu added that he had employed this method with success in the case of a woman aged sixty-three years.

M. Lucas-Championnière considered that the ordinary method of suture gave the most satisfactory results. He asked whether M. Quénu's results were applicable to cases of fracture in a living subject, for he had employed healthy patella in his experiments, whereas a patella which breaks is always in some way altered from the normal. Lancet.

LIABILITY OF A RAILWAY COMPANY FOR MALPRACTICE.

In Jones vs. Railway Company, the Court of Appeals of Texas has handed down an interesting decision, governing the liability of the company in a case of alleged malpractice by one of its surgeons. An action was brought to recover for personal injuries received by the wife of the party suing. The evidence showed that the company tried to obtain a release, and offered as an inducement that they would treat the plaintiff's wife, employing the company's surgeon for this purpose, and that they would pay her board bill. It was held that if the railway company furnished medical treatment as a part of the consideration for the execution of the release, it would be liable for unskilful treatment. This would hold, even if the release were set aside on account of fraud in its procurement.-Journal of A. M. A.

Bartle, M. D., Augusta, Okla., surgeon Rock Island Sys

tem.

II.

"Fractures at the Base of the Skull," A. L. Wright, M. D., Carroll, Ia., district surgeon C. & N. W. Rv.

12. "Head Injuries," J. F. Pritchard, M. D., Manitowoc, Wis., division surgeon C. & N. W. Ry.

13. "Slight Injuries," Judge C. O. Hunter, Columbus, Ohio, attorney Hocking Valley Ry.

14. "Some Remarks Concerning the Ocular and Aural Examination of Railway Employes,' Frank Alport, M. D.. Chicago, Ill.

15. "Traumatic Influence in Producing Movable Kidney," M. L. Harris, M. D., Chicago, Ill.

16. Address. Samuel A. Lynde, Esq., Chicago, Ill., general attorney C. & N. W. Ry.

17. "Immediate Treatment of Eye Injuries," G. E. Bellows, M. D., Kansas City, Mo., oculist U. P. and Kansas City Southern Rys.

18. “Diet, Bearing of, in Surgical Cases," A. B. Brumbaugh, M. D., Huntingdon, Penn., surgeon Pennsylvania Ry.

19. "Physical Examination of Railway Employes," H. B. Jennings, M. D., Council Bluffs, Iowa, surgeon Rock Island System.

20. Paper (title not given), A. H. Andrews, M. D., Chicago, Ill., oculist Rock Island System.

21. Paper (title not given), E. Wyllys Andrews, M. D., Chicago, Ill., consulting surgeon Wabash Ry.

Committee on Arrangements—Wm. H. German, M. D., chairman, 103 State Street; S. C. Plummer, M. D.; A. H. Andrews, M. D.; E. Wyllys Andrews, M. D.

CHRISTIAN SCIENCE AS DANGEROUS FOR ANIMALS AS FOR MEN.

A Texan farmer recently brought suit against a railroad for fatally injuring his team of horses. The testimony was straight, and it seemed that the plaintiff would win his contention without doubt. He went on the stand in his own behalf, and what he said in answer to questions strengthened his case until the attorney for the railroad asked him what treatment he had given the horses. He answered that he has given them the Christian Science treatment only. He had prayed for them, but had put nothing on their wounds and had done nothing to relieve them. The jury thereupon decided that he had caused the death of his horses by neglect, and returned a verdict for the railroad company.

SPINAL PUNCTURE IN FRACTURE OF THE SKULL.

The experiments of M. Tuffier show that the cerebrorachidian fluid, obtained by spinal puncture in the lumbar region, is almost always discolored with blood in cases of fracture of the base of the skull. The procedure is therefore indicated as a diagnostic measure in doubtful cases, and is also of prognostic service, since the degree of discoloration of the fluid varies with the gravity of the lesion.

Railway Miscellany.

Rock Island Occupies Its New Offices at Chicago.

In the early part of last month the Chicago Rock Island & Pacific was installed in its new offices in the new Lake Shore-Rock Island passenger station in Chicago. The work of transferring the offices of the auditor of freight accounts and the auditor of passenger accounts which have heretofore been in the Burton building at Lake and State streets, has already been finished. The Rock Island will occupy one-half of the third floor and all the space on the seventh to the twelfth floors, inclusive. On the third floor will be the offices of the treasurer, paymaster, division superintendent and superintendent of terminals. The general passenger department and purchasing agent will have the seventh floor and the general freight department and engineering department the eighth. On the ninth floor will be the car service department, general manager's office and the offices of the general superintendent and the superintendent of motive power. The tenth floor will be occupied by the executive officers and the legal department. The accounting department will occupy the entire eleventh and twelfth floors. The Lake Shore & Michigan Southern will not begin moving until about the first of May. This road will use one-half of the third floor for the offices of its operating department. On the fourth floor will be the offices of the Indiana Illinois & Iowa, an office of the Pullman Company, and offices of the dining car, medical and other miscellaneous departments of the Lake Shore. On the fifth floor will be the traffic departments of the Lake Shore and the office of W. C. Brown, vice-president of several of the Vanderbilt lines. The second floor of the new building will be a waiting room. The sixth floor has not yet been allotted. On April 25 the Chicago & Alton will begin the work of moving its headquarters to the Grand Central station into the offices at present occupied by the Chicago Rock Island & Pacific. This road will occupy all of the fifth floor, where will be located the offices of the president, general superintendent, official photographer, telegraph and mail departments and a new telephone exchange. The Alton will also have onehalf of the sixth floor, which will be occupied by the legal department. The fourth floor will be occupied entirely by the Alton, with the exception of three rooms, which will be used by the Pullman Company. On this floor will be located the chief engineer, auditor, passenger department, purchasing agent, superintendent of car service, treasurer and pay department. The Alton will also have the Fifth avenue side of the second floor, which will be the headquarters of the freight department.

Spanish Railways in 1902.

The United States consul at Cadiz reports the following facts relating to Spanish railways during 1902, taken from the Anuario de Ferrocarriles: "During the year 1902 231 kilometers (144 miles) of railway and 66 kilometers (41 miles) of tramway were opened to traffic. The railways transported 37,431,038 passengers-4,044,510 more than in 1901. The goods transported amounted to 19,629,268 tons-831,200 tons more than during the preceding year. The gross receipts were 283,829,344 pesetas ($54,779,063), against 265,366,601 pesetas ($51,275,754) in 1901, an increase of 18,463,043 pesetas ($3,563,308). The daily traffic was 53,773 tons and the number of passengers transported daily 102,550. The government received in taxes from railway transportation 23,771,438 pesetas ($4,587,887), an increase of 680,677 pesetas ($131,371), as compared with 1901." Supplementary to these facts, attention may be called to an article in the Revue Generale which, among other things, refers to the unfavorable physical conditions affecting the maintenance of way. This is made unusually difficult, says this article, because of the great climatic variations-heat and cold, drought and floods. Timber decays more rapidly than in other countries. Fences are not continuous, so that cattle may run about and over the tracks at