ever possible, although as a rule there is some leakage of urine through the urethral and perineal wounds during the progress of convalescence. The object is, of course, to reduce the formation of cicatricial tissue to the minimum. In any event a soft catheter should be passed from the meatus to the site of injury, then on into the bladder, and tied in place, to serve the double purpose of diverting the urine away from the perineum and forming a support for the new tissue to build upon. The bad result of draining the bladder through the perineal wound only is well illustrated in a case alluded to by L. B. Bangs (Annals of Surgery, XXVII, page 84.) Here no attempt was made to repair the defect and the urethra, anterior to the wound, became occluded, requiring a difficult operation ultimately to restore its continuity.

A case covering the points involved very typically having come under my observation within the last month, I can perhaps do no better than read a brief clinical description of it:

P. K., a farmer, aged 63, went out to the barn late on the evening of November 11 to tie up some colts that were kicking. After attending to this he climbed over the manger in front, and in doing so, fell astride the top plank with considerable force. The pain was not great, but he realized that he was seriously hurt and secured assistance to get back to the house.

Seeing him at 10 p. m. the same night, I found his general condition good, with no evidences of shock present. Locally, the perineum was bruised and tense, the skin being unbroken except for a linear abrasion on the inner surface of the right thigh. A little blood was oozing from the meatus, but no urine could be passed nor did he then feel any desire, stating that he had urinated at 5 p. m. I made a diagnosis of rupture of the urethra. Not having been informed of the nature of the injury and the accident having occurred three miles from town, I was then unprepared for further investigation or intervention, and not being desirous of attempting a perineal section with the poor artificial light at my command, I decided to content myself with giving an opiate until morning. At 2:30 a. m., however, I found myself confronted with the necessity of evacuating the patient's bladder, and, being equipped with a full supply of catheters, etc., this time I tried to enter the bladder by the urethra, but without success, so resorted to suprapubic tapping, removing 24 oz. of clear urine. A rectal suppository of opium, belladonna and hyoscyamus was then inserted and the patient rested well until after daybreak, and at 10 o'clock I operated, assisted by two of my confreres.

After the usual preparations had been made, a large sized sound was passed down to the site of rupture, and pressed downward and outward; this served as the guide

for the usual median incision, which immediately exposed the ragged edges of the distal end of the rent. The tissues were so full of dark, tough clots that the vesical end of the urethra was found and identified with great difficulty. It resembled more than anything the torn end of an artery, with a clot protruding. In place of the sound, a Nélaton catheter was passed from the meatus to the wound, then guided into the bladder. The clots having all been previously turned out of the tissues, 5 interrupted sutures were inserted, drawing the divided.

ends of the urethra together without much tension. The insertion of these stitches was no easy matter on account of the depth at which it was accomplished, the friability of the tissues and the oozing of blood, which was constantly in progress despite all efforts to control it. The suture material was Pagenstecher's celluloid linen thread, and it served the purpose admirably. The perineal incision was left wide open, but packed tightly with selvedged-edge gauze strips.

This was not disturbed until the fourth day, when it was removed and not replaced, a light external dressing of gauze being sufficient to absorb the slight discharge, and such urine as subsequently escaped through the wound. The catheter was left in place until the tenth day, then permanently removed, it being found that the patient could micturate at will. It had been removed a couple of times during that period for sterilization and replaced. There was some tendency to urethritis during the latter part of the period, but it promptly subsided upon removal of the catheter. Urotropin in 5-grain doses four times daily was given throughout and had the desired effect in keeping the urine normal. About the ninth day it was noticed that there was some leakage through the perineal wound; this, 21 days since the operation, is still persisting. Quite often the patient passes 6 or 8 ozs. of urine without any perineal leakage, but the rule is that some escapes, and this may continue for some time. The patient was able to sit up a little on the fourteenth day and is rapidly regaining strength. The condition of the wound is excellent.

THE RAILWAY MAN'S STOMACH.*

BY ELLSWORTH WILSON, M. D., OF ALVA, OKLA.

By continually violating the laws of nature, any organ of the human body will eventually weaken. All will agree that the life of the railway man is one of irregularities, and none will doubt that the stomach is the most neglected organ in all the callings of man.

The stomach is the natural receptacle for the nourishment of the body, there to remain during digestion, then to be passed into the intestinal canal for further digestion and absorption. It receives alcohol, hot drinks, sometimes sufficiently heated to cook an egg; cold drinks and pastry that many animals will refuse. Thus the stomach becomes a sieve through which man subsists. It should normally have a rest between meals.

The eating of a reasonable amount of food at regular intervals is more conducive to a long, happy life than the obeying of any other law of health, unless it be that of by the majority from infancy to the grave. A man's shelter and clothing, yet this law is almost daily broken working ability can be measured by the condition of his stomach.

In health the care of this important organ becomes of secondary consideration; in sickness it has been the first

for consideration since and before the medical era. A diagnosis of "stomach trouble" is very acceptable to the laity, after a minute or thorough examination of a patient from infancy to the aged. It has become the dump

*Read at first annual meeting Rock Island System Surgical Association, Kansas City, December 3 and 4, 1903.

ing ground for ignorance and doubt by all. Too often the practitioner ripens from the medical school with the understanding that the stomach is a hollow viscus in the abdominal cavity; that it is subject to disorders which are brought about by a deficiency of pepsin or hydrochloric acid; hence these preparations are prescribed in unlimited amounts in the early days of most physicians.

Surely no calling is more conducive to the development of digestive disturbances than that of the railway mantired, nervous and hungry as the engineer is after a 12hour run without anything to eat, in this condition he takes his meal, manifesting less science or knowledge than does his engine in utilizing coal and water. Yet man is the ruler of all beasts of the field, and the maker of all machinery, as well as the destroyer of the most wonderful organ-the stomach.

There are few medical men who refuse to believe that most diseases are produced by the introduction into the system of some of the microbe family, but this theory will almost vanish if one watches the passenger conductor, who gathers bacteria on his hands from a loaded train, with sometimes germs from all nationalities and districts of the globe. In this condition he will stop for a 10-minute dinner at some lunch room which, as a rule, is an expensive laboratory where one may find a greater variety of bacteria than in the much-talked-of "individual communion cup." With unwashed hands he soon fills his. stomach with its meal, ready to be acted upon by the gastric juices, while he proceeds with his train. procedure may be repeated one to four times during the "run." Often the conductor will be seen using his mouth for a third hand by holding tickets, money, pencils, etc., thus making possible another source for the entrance of

various bacteria into the stomach.

This

I do not deem it necessary to follow the various kinds of laborers in the service of a railroad company, as what applies to one will, in a way, apply to all, and to man in general.

One common form of acute gastritis was described by my professor in medicine as "gastric embarrassment," which presents the following conditions: It comes on shortly after meals, a predisposed stomach, nervousness, eating a cold meal, cating and going out into the cold, eating too much. There is weight in stomach, pulse is rapid and feeble, profuse sweat, face is congested, autointoxication may result with a temperature of 105°. Almost immediate relief is obtained by vomiting. Dilatation is one of the unpleasant results of the railway man's habits in diet; it is often due to repeated attacks as above described. All are acquainted with this very common affection.

Treatment. There is no class of patients who, to be successfully treated, require an accurate diagnosis more than those with gastric troubles, yet the majority are treated for "dyspepsia," regardless of the causes and findings, which are ignored.

Prophylaxis is to be urged, but under the present management of railroads little can be obtained by such, although improvement could be made by:

etc.

1. Eating at as near regular intervals as possible. 2. More care with the dinner pail as to temperature,

3. Greater attention should be given to cleanliness. In the acute forms of gastritis the alimentary canal should be emptied by vomiting, when indicated, with the use of apomorphin hypodermically, rectal enema and saline cathartics. There is no class of patients that are so unfavorably impressed with the treatment and so gratified from its results as are these, especially when the stomach tube is used to thoroughly cleanse the stomach, and this alone, with care in diet, forms a valuable treatment. All gastric troubles embrace a class of patients who require to be studied and treated individually, according to the indications.

DISCUSSION.

Dr. D. R. Fly, Amarillo, Tex.: I would like to ask the essayist, in closing the discussion, if he thinks the condition of the railway man's stomach is due to his position or to the eating houses where he gets his lunches? In my opinion, the stomach trouble ought to be called "the pie stomach," because railroad men go and get a piece of pie or a cup of coffee at almost any time. This is especially true of freight men, and I have found a great deal of trouble among railroad men from irregular eating. With the vocation they follow, with the exercise they take, they ought to be able to digest their meals normally.

Dr. T. J. Maxwell of Keokuk, Ia.: I think the condition. of the railway man's stomach is due to the fact that he bolts his food like a dog. He does not chew it.

Dr. L. W. Littig of Iowa City, Ia.: A word in defense. of the men accused, namely, that these individuals bolt their food. We must remember that these men have arduous duties to perform; they take their meals rapidly, and the condition of their stomachs may not be altogether due to eating pie.

Dr. S. B. Hall of Rock Island, Ill.: I think the average railroad man has the best stomach of any class of men with whom I am familiar. So far as his stomach is concerned, I think he comes next to the donkey and ostrich. I have seen railroad men, after a run, eat two pieces of mince pie, drink four cups of coffee, and then go to sleep. Any man who can do that can certainly take care of his stomach.

Dr. Leroy Dibble of Kansas City, Mo.: The idea of calling the condition "pie stomach" only covers half the ground. Take a piece of beefsteak that is tanned on both sides, and if a man can digest that pie is not in it. Soleleather is not in it. When we eat out of doors, at depots and other places, food that is improperly cooked and hard to digest, we pay the penalty about our time

of life.

Dr.

: I think the majority of these cases of stomach trouble among railroad men is due to several causes, and among them I would mention eating hastily indigestible articles of food and then resuming work immediately after. It is astonishing to see how some railroad men rush up to a lunch counter and order a sandwich and a cup of coffee. I remember very well the first time I got hungry in taking a railroad trip. I rushed in to the lunch counter with the rest of the people, took a sandwich and a cup of coffee, but I left that sandwich behind about five miles from the station. (Laughter.) I was standing on the rear end

of the car at the time. I have never indulged in a sandwich since, and I believe it has been a great benefit to my stomach. I exclude salads and such things from my diet. The railroad man's stomach is no different from that of any other man; he has to eat in a hurry, and go to work in a hurry.

Dr. E. L. Brownell of Spirit Lake, Ia.: I do not think so much is due to the food we eat as to the manner in which we eat it. We are all liable to forget that we are not like a cow that chews its food a second time, and that there are no teeth in the stomach. It is not what we eat so much as the way we eat it. We bolt things down in a railroad restaurant, and pour them down.

When I began the practice of medicine, like a good many of my confrères, I knew little about asepsis and antisepsis. I believe it is claimed now that we have more catarrh, more dyspepsia, than we did years ago. I would like to ask if it is possible that we have more of a septic condition in our atmosphere than we had 25 or 30 years ago. Is that claimed or disclaimed by authorities? It seems that one can hardly pick his finger nowadays without getting infection. Dr. Senn unfortunately pricked his finger in operating, it is said, and had infection following it. It is a little singular, to say the least, how easily some men become infected, while others under the same circumstances and conditions escape in

fection.

Dr. Wilson (closing): I do not see that it is necessary for me to add anything more to what has been said. PHYSICAL EXAMINATIONS IN OKLAHOMA.

The Supreme Court of Oklahoma holds, in City of Kingfisher vs. Altizer, that the courts of that territory can not order a party bringing an action for an injury to the person to submit to a surgical examination in advance of or during the trial of the cause. It says that one may expose his body, if he chooses, with due regard to decency, and with the permission of the court; but he can not be compelled to do so in a civil action without his consent. Where a person unreasonably refuses to show his injuries when requested to do so that fact may be considered by the jury as bearing on his good faith, as in any other case of a party declining to produce the best evidence in his power and under his control. -Ex.

THE TREATMENT OF SEVERE BURNS WITH GLYCO-THYMOLINE.

Dr. F. M. Robbins of West Springfield, Mass., cites a case which is of some interest as showing unusually favorable results in a case of burns of the third degree. The patient, a woman of 20, was severely burned by the explosion of a lamp. The burned area extended from the ankles to the abdomen, while smaller areas were burned on the trunk. Dr. Robbins was called in nine days after the accident, being the fourth physician who had been in attendance. The patient was sinking and the prognosis seemed to be death within twenty-four to thirty-six hours. Large sloughs were separating from the calves and from the posterior portions of the thighs. Owing to the pain and lack of sleep, the patient was very

much exhausted. All the dressings were immediately removed and the wounds washed with a 25 per cent solution of Glyco-Thymoline and then dressed with a 50 per cent solution of the same preparation. Within half an hour the patient had dropped into peaceful slumber and was discharged completely cured within a month. For a short time after leaving her bed she was compelled to use crutches, but within a few weeks she recovered complete command of her limbs. One remarkable feature of the case is the complete absence of scars and cicatricial tissue. New York Medical Journal.

FURNISHING MEDICAL TREATMENT
EMPLOYER.

BY

The Court of Civil Appeals of Texas says, in Galveston, Harisburg and San Antonio Railway Company vs. Hennigan, that while, independent of a contract, no duty rests on a master to furnish his servants with medical

and surgical treatment, yet, if he undertakes to furnish such treatment, the law imposes on him the duty to use and skillful physician and surgeon for that purpose. reasonable care in engaging the services of a competent And if, through the failure so to do, the physician employed is incompetent and unskillful, and through such incompetency, etc., in the treatment of the servant injures him, the law holds the master responsible for his failure to discharge the aforesaid legal duty. Such liability is independent of any duty arising from a contract. -Ex.

TEMPERATURE IN SHOCK.-Any experimental work which elucidates this little known condition is welcome.

Guy C. Kinnaman, from a long and extensive series of experiments, whose scope and number lend particular weight to his observations, concludes as follows: (1) Shock must not be considered as due to the lowering or exhaustion of one bodily function, but as a composite condition embracing an interference with the normal height of the blood pressure with the respiratory act and with a marked fall in the body temperature. That there is a relationship between the fall in body temperature and shock is evident by considering (a) that in one series, the fall in temperature was the sole cause of shock; (b) that by continuous bath the temperature fell but one degree. The respirations increased, instead of diminishing, and the fall in blood pressure was greatly lessened. (c) That by raising the body temperature previously lowered in shock, the respiratory rate was increased and the blood pressure raised. Of the three factors concerned, the temperature commands the first place by its powers of production, limitation and amelioration of a composite condition-shock.—Med News.

INFLUENCE OF TRAUMATISM ON THE RECURRENCE OF MALARIA.-Duret states that it may be questioned if fever which comes on after an operation in a malarial patient is due to infection or malaria. The course of the temperature ordinarily suffices to clear up the diagnosis. In every case it is certain that the malarial symptoms may be renewed by traumatism. Verneuil has noted a recurrence of fever in malarial patients in cases in which it was impossible to admit infection, after simple contusions, for example.-Med. Record.

The following companies have up to date complied with our requests to furnish transportation for their own surgeons and honor requests from managing officials of employing lines: Baltimore & Ohio, Central Vermont, Chicago, Burlington & Quincy, Chicago Great Western, Chicago, Milwaukee & St. Paul, Chicago & North-Western, Chicago, Peoria & St. Louis, Cincinnati, Hamilton & Dayton, Delaware, Lackawanna & Western, Erie, Grand Rapids & Indiana, Grand Trunk, Illinois Central, Iowa & St. Louis, Lake Shore and Michigan Southern,

April, 1904.

Missouri, Kansas & Texas, New York, Ontario & Western, Quincy, Omaha & Kansas City, St. Louis & San Francisco, Wisconsin Central.

The following will comply with requests for their own surgeons and those of other companies who devote their whole time to railway work, or are on the pay roll: Atchison, Topeka & Santa Fe, Baltimore & Ohio Southwestern, Pennsylvania Lines-West.

A. I. BOUFFLEUR. Chairman Committee on Transportation.

PULLMAN SLEEPERS.

Members (as usual) will pay their sleeping car fare to Chicago, and on presentation of receipts for berths fare, and paid-up membership in the I. A. R. S. to Supt. C. R. Wagner, Room 309, Pullman Bldg. (southwest corner of Adams street and Michigan avenue), passes for return trip will be issued.

HOTELS.

Chicago is abundantly provided with hotels to suit all tastes and purses. Among them are:

Sherman House, Randolph and Clark, two blocks from. meeting place.

Great Northern, Jackson and Dearborn, six blocks from meeting place.

Hotel Morrison, Madison and Clark, four blocks from meeting place.

Palmer House, Monroe and State, five blocks frommeeting place.

Saratoga, four blocks from meeting place.

Union, 111 Randolph, two blocks from meeting place. Bismarck, 180 Randolph, four blocks from meeting place.

Grand Pacific, Clark and Jackson, seven blocks from meeting place.

Stratford, Jackson and Michigan avenue, nine blocks from meeting place.

Auditorium and Auditorium Annex, Congress and Michigan avenue, eleven blocks from meeting place. Briggs House, Fifth avenue and Randolph, four blocks from meeting place.

Brevoort Hotel, 180 Madison street, five blocks from meeting place.

These are practically all on the European plan. No details can be given as to rates, as these vary according to location, number in room, with or without bath, etc. Headquarters at Sherman House.

CUSPIDORS IN CARS.-The following rule, on March 31, will replace the previously existing clause in the disinfecting instructions of the state health officer of Texas, as applied to passenger coaches and sleeping

cars:

"Each passenger coach or sleeping car used for passengers must be provided with one cuspidor for each two double seats, or every four chairs. Each cuspidor must contain not less than six ounces of a disinfectant solution

approved by this department. The cuspidors to be emptied, washed in similar solution and replenished each trip or every twenty-four hours."

First Aid and Emergency.

(Conducted by CHARLES R. DICKSON, M. D., Toronto, Can.)

FIRST AID AMONG FARM LABORERS IN RUSSIA.

L. D. Bertenson calls attention to the fact that over 12,000 persons are seriously injured annually in European Russia in the course of agricultural pursuits. Most of these accidents are such that they lead to complete loss of working capacity. During the past year the Minister of Agriculture has formulated a set of rules for the prevention of these accidents. One of the measures suggested was that the manufacturers should be ordered to supply all machinery with devices to prevent accidents. The provincial administration shall insist on the observance of certain rules for the management of farming implements and machinery, such as the admission of children to the operation of the machinery. The author thinks that all these rules are not so effective as would be the thorough organization of a "First Aid corps" among the farmers. Children under 15 should be prohibited from working with any agricultural implements or machinery. All work should be supervised by persons thoroughly acquainted with the mechanism of the machinery as well as First Aid. Such persons should always be present on isolated farms.-New York Med. Journal.

FIRST AID IN THE ARGENTINE REPUBLIC.

This is the only country so far to regulate First Aid by law.

M. Wernicke, professor of pathology at Buenos Ayres, proposed the following rules, which have been adopted: The cases in which a druggist may furnish First Aid. to the public after an accident are very numerous.

It shall be deemed contrary to public policy to prevent druggists furnishing this aid in such cases.

The medical knowledge of the druggist is sufficient for him to undertake provisional treatment, and as this provisional treatment is generally based on the rules of antiseptics, therefore,

The National Board of Health decrees that it be permitted to the druggist providing he complies with the following conditions:

No wounded person shall be attended by a druggist

save for a recent wound.

Nothing but a 4 per cent solution of boric acid or a 5 per cent solution of salicylic acid shall be used for irrigation.

Sponges must never be used for cleansing the wound, only tampons of hygroscopic cotton.

Nothing shall be used to control hemorrhage save compression, either by cotton pads saturated in the solution, or direct compression of the arteries.

After the flow of blood has ceased, and the wound has been carefully irrigated, the edges of the latter are to be brought together by strips of adhesive plaster, taking

care to not cover the wound completely.

Over the plaster is placed a layer of hygroscopic cotton fixed in place by a gauze bandage.-La Médecine Mod

erne.

Extracts and Abstracts.

THE LEGAL STATUS OF THE X-RAY.*

BY HON. W. W. GOODRICH, PRESIDING JUSTICE APPELLATE
DIVISION OF THE SUPREME COURT OF THE
STATE OF NEW YORK.

A preliminary precept to be laid down in referring to the law of evidence is that unless excluded by some rule or principle of law, all that is logically probative is admissible in evidence, but, as Mr. Justice Stephen, in his Digest of the Law of Evidence, says: "The great bulk of the law of evidence consists of negative rules declaring what, as the expression runs, is not evidence."

The general rule with regard to ordinary photographs has long been that wherever the person or thing would, under general rules, be relevant if produced in court, or the jury would be permitted to see it if convenient, a photograph of such person or thing, if properly authenticated, is admissible when the original cannot be seen. Whenever the jury are likely to be materially aided by the opinions, on matters of fact, of persons specially qualified, they should have them, and, for the purpose of illustrating and making clear the testimony of medical and surgical experts, photographs taken by the Roentgen or X-ray process have been admitted as evidence in the courts of several of the states. A reference to these cases will show the present status of the law upon the subject. The first case in which the question arose in this country is unreported, but there is a summary of it in the Chicago Legal News. It was decided in Colorado, in 1896, and in admitting the X-ray photograph, the learned judge (Lefevre) said:

"During the last decade, at least, no science has made such mighty strides forward as surgery. It is eminently a scientific profession, alike interesting to the learned and the unlearned. It makes use of all science and learning. It has been of inestimable value to mankind. It must not be said of the law that it is wedded to precedent; that it will not lend a helping hand. Rather let the courts throw open the door to all well considered scientific discoveries. Modern science has made it possible to look beneath the tissues of the human body, and has aided surgery in telling of the hidden mysteries. We believe it to be our duty in this case to be the first, if you please, to so consider it, in admitting in evidence a process known and acknowledged as a determinate science."

Probably the leading case in this country on the subject under discussion is that of Bruce vs. Beall (99 Tenn. 303), decided September 30, 1897. Judge Beard, writing for the court, said: "In the progress of the trial, one Dr. Galtman was introduced as a witness, and he was permitted to submit to the jury an X-ray photograph, taken by him, showing the overlapping bones of one of plaintiff's legs at the point where it was broken by this fall. This was objected to by the defendant's counsel. This picture was taken by the witness, who was a physician

and surgeon, not only familiar with fractures, but with the new and interesting process by which this particular *Read at a meeting of the New York State Medical Society, October 13, 1903.