Skiagraphy in

Injuries and Disease of Bones.

We are reminded, by two volumes published recently by Dr. W. B. Hopkins of Philadelphia and by Drs. C. L. Scudder and F. J. Cotton of Boston, of the great services rendered by our surgeons with regard to our knowledge of the clinical features and the treatment of fractures.

In both works we meeet with clear evidence of the great importance attached by modern writers on fractures to the use of the Roentgen rays for purposes of diagnosis. Both Dr. Hopkins and Dr. Scudder have of course made free

application of this method, and skiagraphs of different forms of fracture are scattered profusely through their pages. The former author evidently looks upon skiagraphy when practiced by experts as a useful help in diagnosis, and deems it unnecessary to point out the difficulties that await, in the practice of this method, less competent or less experienced interpreters than himself. Dr. Scudder, on the other hand, who is convinced that the use of the Roentgen rays has contributed much toward an accurate interpretation of the physical signs of fracture, has, nevertheless, done good service by showing indirectly that this aid to diagnosis should not be implicity trusted, and that it is in its present stage of development capable of doing positive mischief.

He has included a treatise by Dr. E. A. Codman on the Roentgen ray and its relation to fractures. In this chapter it is pointed out that much of the real value of skiagraphy has been impaired by a premature and impulsive revelation of its uncontrolled results to the general public. He thinks it unfortunate that Roentgen's original article, which is regarded as a model of scientific accuracy, was not so widely published in the first place as the many sensational reports and absurd illustrations that appeared in newspapers. The unfortunate result is not only that it will be years before the public is freed from its first erroneous impression, but that during the process of enlightenment much trouble will be caused both to surgeons and their patients. The chief cause of so much mischief, Dr. Codman states, is the fact that so many people have been led to confuse a Roentgen-ray picture with a photograph, and to forget that it is but a shadow picture, in which the shadow is more or less distorted. In many of these pictures he shows that not only may the bones be magnified, but also the interspace between them. It is very necessary to guard against erroneous conchi

sions in some injuries, especially in those about the elbow. In all articular injuries in young subjects, the presence of cartilage in different stages of ossification presents great and perplexing difficulties in interpretation.

It is, as Dr. Codman holds, of the utmost importance that every practitioner who uses this means of diagnosis should fully understand the way in which any conclusion should be drawn from one of these pictures. "Though the pictures themselves are inaccurate as pictures of the object, they are accurate pictures of the different parts of the object, and the reasoning of conclusions drawn from them should be exact." Further suggestion of the danger likely to occur from a blind and unscientific confidence in skiagraphy is afforded by the report of the conclusions of the American Surgical Association on the medico-legal relations of the Roentgen rays, in which it is stated that the surgeon should not forget the grave possibilities of misinterpretation, as there is evidence that plates may be made that will fail to reveal the presence of existing fractures, or will appear to show a fracture that does not exist.

In the appendix to Carl Beck's recent work on fractures there is an excellent paragraph upon " errors of skiagraphy," in which are pointed out the chief of the many difficulties that hinder a lucid interpretation of the photographic appearances. So far as treatment is concerned, the author advises the use of the plaster-of-paris splint wherever possible. Massage is considered a “splendid adjunct" to the "good old immobilization treatment." This work contains a certain, not inconsiderable, quantity of original and useful information, and is thereby justified of existence. The author is not quite at home with the English language, as is shown by the use of words which neither custom nor scholarship can sanction.

THE MANTLE OF PROPHET KNEIPP. When a prophet is translated to a higher sphere there is sometimes a fight among his disciples for his mantle. The public of Austria are now being edified by such a tug-of-war for the outer garment of the famous prophet of Wörishofen, the late Pastor Kneipp. On the one hand, Dr. Baumgartner, a member of the medical profession; on the other, Father Reile, Prior

of the Brothers of Charity, claims the apostolic succession of the Kneipp cure. The prophet himself is said before he passed behind the veil. to have left the choice of his successor to the Brothers of Charity at Wörishofen. They have naturally chosen their prior. But this is not accepted by the other side as a satisfactory settlement of the matter. The quarrel is a very pretty one as it stands, as Sir Lucius O'Trigger would say. We venture to suggest as an appropriate solution of the difficulty that the contending parties should refer their differences to the arbitrament of the weapon with which the man over whose inheritance they are squabbling battled with such strenuous self-confidence against disease. Let them fight the matter out with douches. There is a large armory in the Master's book to choose from. It would be a novel form of combat, which would not come within the scope of the Church's ordinance against duels. Angry passions would be cooled without letting of blood, and no harm would be done unless the shock of an unaccustomed bath should prove fatal.

CREMATION IN FRANCE.

The French Society for the Propagation of Incineration recently held its annual general meeting in Paris, under the presidency of Dr. Bourneville. The General Secretary, M. Salomon, in his report reviewed what had been done during the past year toward the increased use of cremation throughout the world. He mentioned that in Germany there were at the present time 40 cremation societies with a total membership of about 12,000; that in the United States there were 25 crematories, and in Italy 22; that in Sweden cremation is becoming more and more frequent; and that in Copenhagen in 1890 the number of cremations carried out was 70. In Austria, Holland, Belgium, and in Spain serious efforts were being made for the introduction of cremation. With regard to Paris, M. Bourneville gave statistics of incinerations at PèreLachaise in 1900, as follows: At the request of the family of the deceased, 297; human remains from hospital, theaters, etc., 2752; embryos, 2776; total, 5825. He concluded by moving resolutions asking for a modification of the law that would allow of the cremation of persons killed by accident on public roads, etc.; the creation of a crematorium in the cemeteries of the South and West; and the completion of that in the PèreLachaise cemetery. With regard to England, in addition to the crematorium of the Cremation Society, which was erected in 1879, there are now crematoria in Manchester, Liverpool, and Glasgow; while at Hull, Birmingham, and in

THE USES OF CURIOSITY.

Professor Clifford Allbutt recently gave an address which he began by explaining how it was he had taken up the medical profession. When he became a student anyone who desired to know about things, anyone, for instance, who was interested in butterflies, was immediately marked off to be a doctor. In the little laboratory he had made at home, where he performed certain experiments on rats, and tried to gratify the inordinate curiosity with which his mind was then possessed, he did what work he could, and though his investigations led his relations to say that he must go in for medicine, he had not yet been able to satisfy his curiosity to the extent that he would like. Allbutt then quoted from Hobbes the following: " Curiosity is in man such as in no other living creature; so that man is distinguished not only by his reason but also by this singular passion, from all other animals, in whom the appetite for food and the other pleasures of sense, by predominance, take away the care of knowing causes; which is a lust of the mind that, by a perseverance of delight in the continual and indefatigable generation of knowledge, exceedeth the short vehemence of any carnal pleasure."

It was a misfortune that this spirit of curiosity which was so stimulating should be choked systematically as it was from the very earliest days. A child was more or less interested in the concrete but not in abstract terms. A boy, however, was set to learn by rote abstract generalizations of the meaning of which he had not the faintest notion, and his curiosity in regard to things was extinguished early in life. Curiosity, however, had a chance of fair play in medical schools, and the medical student was incessantly watering the plant of curiosity.

Medical teaching used to consist in the handing down of abstract generalizations from one generation to another. In the present day there were three methods on which the study of medicine rested-observation, experiment, and the experimental method. By the experimental method he meant the systematic investigation of a subject step by step.

Referring to the accusation of medical men. experimenting on their patients, the professor said that medical men must be incessantly trying experiments because every sick man was a riddle,

and an exceedingly complex one. He contended that the smallest dose of domestic medicine was an experiment, and that scientific habit of minds and scientific methods had not conduced to any indifference to the welfare of the patient. The heavy bleeding and heavy purgation of their predecessors were experiments which were made with ignorant readiness, but the scientific methods of to-day made them aware how enormously difficult it was to treat patients without sometimes doing more harm than good.

"THE CRY IS STILL THEY COME!" The extraordinary multiplication of of new drugs, especially new synthetic bodies, recommended by their vendors as cures for various diseases, often for many diseases, is, we are glad to see, attracting the attention of the medical profession in Germany, the country from which most of these discoveries or inventions hail. At the German Scientific and Medical Congress, Professor W. His of Leipzig-read a very outspoken paper on the evils which arise under the present system by which every manufacturer of a new drug thinks it necessary to obtain testimonials from medical men. Professor His recommended that professional opinions should be confidential, that the wording of any testimonials given should be guarded, and that no remuneration should be asked for or accepted. The congress appointed a committee to report on the whole matter, but the Deutsche med. Wochenscrift, in a recent issue, expresses the opinion that no private committee can do the work, and suggests that a central organization for testing new drugs should be established. Our contemporary states that in 1899-1900 alone no fewer than 126 new drugs were put on the market, and it thinks that such an official examination as it proposes might have the effect of moderating the too great zeal in the finding of new drugs displayed by some medical practitioners and chemists. We imagine that most practitioners in this country, who find their letter-boxes stuffed every day with pamphlets and circulars, and little tins and bottles of samples, will be disposed to agree that our eminent German contemporary speaks the words of

wisdom.

APPLICATION OF WATER IN DIABETES.
S. BARUCH, M. D.

It has long been my custom to insist upon regular and sustained exercise, by which alone. muscular glycogenesis can be stimulated. This requires great moral courage and energy; so

great are the languor and inertness of the patient that it is almost impossible to overcome them. And here is the point where hydrotherapy enters as an important remedial agent. That great physiological stimulant, cold applied through the medium of water, especially when combined with the mechanical stimulation of the douche, arouses nervous activity, increases vital capacity, contracts muscular tissue, improves nutrition and hematosis, and thereby increases energy, removes languor and indisposition to exercise when moral suasion has failed, and even the certain prospect of farther invalidism has not stimulated the diabetic to effort. The systematic daily neurovascular training of the cold douche has often requited me by a renewal of life, a quickening of all the functions, an elevation of vital activity, which brought the patient to tolerate and even enjoy muscular exercise without fatiguing him. Not alone do we thus obtain the salutary influence upon the muscular glycogenesis, but the improvement of the patient's general health contributes to the enhancement of his digestion, assimilation, and more normal excretions; weight is gained, and patient and friends are cheered. Such stimulating effect upon the nervous system, in a disease which is so largely neurotic in many instances, conduces vastly to the restoration of health.

I have frequently observed that strict dietetic rules may be relaxed when systematic exercise and hydrotherapy are added to the management. of the diabetic. Just as exact temperatures, pressure, and technique are insisted upon, so must an exact record of walking exercise, which is the best, he made upon the pedometer, for guidance in future prescriptions. This disease presents a striking illustration of what I have often emphasized, in that hydrotherapy, though not directly curative, aids by enhancing the resisting capacity of the human organism.

One brief clinical history of a case of long enduring restoration must suffice to illustrate my statements.

Mrs. I., æt. sixty-three, consulted me March 2, 1892, for great lassitude, loss of appetite, depression of spirits, and other symptoms pointing to diabetes. Examination revealed six per cent. of sugar, specific gravity 1040, quantity in twenty-four hours eighty-one ounces. Weighing, nude, 253 pounds, and being quite inert and languid, exercise seemed utterly out of the question. A strict anti-diabetic diet was prescribed, and rigidly adhered to, but she could not walk two blocks without dyspnoea and great exhaustion, despite the most laudable persistence in her efforts to carry out my instructions. one month she lost only one-half per cent. of sugar. In order to reduce her weight and improve nerve and muscle energy, she was induced

In

to drive in a carriage five miles to receive the following treatment: Once a week she received a hot-air box bath until she perspired freely. This was followed by the cicular douche at 90° for half a minute, and by the fan douche at 80°. This was succeeded by active massage and resisting movements for fifteen minutes. Five times a week she received a tonic hydriatic procedure, beginning with a dry pack for half an hour, for the purpose of filling the cutneous vessels, and followed by a general ablution at 70°, with good friction. On April 15, or in two weeks, she had lost six pounds and was able to walk six blocks twice a day. A week later specific gravity of urine was five points less, sugar three-quarters per cent. less. Wet packs in sheets wrung out of water at 50° were given for forty-five minutes, followed by half baths, of ten minutes, at 85°, with active friction in tub, followed by massage and resisting movements for fifteen minutes. The object of this procedure was to increase tissue change and improve the circulation in the muscles. This effect was increased a month later by substituting the jet douche under thirty pounds pressure, at 60° F., for the half bath. It was delightful to observe how this large and unwieldly woman gained in energy, desire and ability to walk, so that at the expiration of three months, despite the summer heat, she was able to walk four miles a day, morning and evening. The diet remaining the same, sugar decreased gradually from the time. she was able to walk a mile daily, until eight months after beginning treatment she was entirely free from sugar. She remains free from diabetes, although eight years have elapsed. Her diet is no longer strict, the only precaution being to resort to more muscular exercise when farinaceous food is indulged in.

A FAMOUS GENERAL PRACTITIONER. The Association of German Engineers has recently placed a memorial tablet on the house at Heilbron in which lived Robert Mayer, the discoverer, or, as the Encyclopedia puts it, "an independent a priori propounder of" the law of the conservation of energy which Mayer himself called "indestructibility of force." Mayer was all his life a general practitioner, and apparently not a very successful one, as may be gathered from Tyndall's words in announcing his wish "to raise a noble and suffering man to the position which his labors entitle him to occupy." Mayer was born at Heilbron in 1814, and studied medicine at Tübingen, Munich, and Paris. He made a voyage to Java as surgeon of a Dutch ship in 1840, and on his return settled down

in his native town, where he held an official medical appointment. He died in 1878.

OBSERVATIONS ON SEASICKNESS.

JAMES R. WORTABET, M. B.,

Late Surgeon R. M. S. Dunvegan Castle.

I have acted as a ship's surgeon for a considerable period of time. I have traveled more than one hundred thousand nautical miles, and I have had usually under my care several hundred passengers besides the crew. Though well inured to sea life, I myself have suffered on one or two occasions, and I found I nearly always did so when I went to sea with loaded bowels, and presumably a full gall bladder.

My own feelings and observation led me to believe that all my symptoms were referable to the abdominal organs, none to the cerebral, although I quite believe in two distinct types of the sickness. I am quite convinced that certain precautionary methods adopted by experienced travelers almost completely prevent their being affected to any extent-namely, by taking a saline purgative the day or so before traveling, by adopting the recumbent position, and on all occasions avoiding oleaginous smells and the company of those who are seasick, as example seems a powerful excitant to seasickness.

There are also certain stomachic sedatives which, if taken at once, undoubtedly tend to prevent sickness, notably potassium bromide and some similar drugs; but, having given a fair trial to all the most lauded preparations which have been brought forward as panaceas, I have found none of them infallible. I have noticed that patients who went at once to sleep on coming abroad, either from the effects of a dose of chloral taken at their own instigation, or from the effects of alcohol, often escaped the malady, which, on other occasions, they did not. But to show how uncertain deductions from this statement are, I may mention that both sailors and firemen not infrequently come on board the worse for liquor, and almost invariably are seasick before getting into their normal condition.

I believe that more depends on the kind of motion of the ship than on nearly anything else, although, as I have pointed out, the recumbent position renders one less liable to this ailment than the erect. With a head sea and slight pitching far more people are affected than even with severe rolling, and singularly the majority of the people affected, if asked to describe their sensations, refer them in nearly all cases to the abdomen primarily, and I can myself corroborate this experience, the downward motion of the vessel seeming to have distinctly more effect than the

upward. An experience I had with about five hundred Hebrew pilgrims at Jaffa most strongly confirms the above statement. I do not at all question the statement that a certain proportion of cases have their origin in the cerebral centers primarily, but I should not attempt to venture on a distinct localization. It has been pointed out, with what certainty I cannot tell, that the sensations occasionally experienced in a train. passing through a tunnel or in a lift in motion are in some way referable to the superior semicircular canal. Dr. Savory ascribes the whole mischief to the disturbance of the endolymph; but if such be the case, why should the vast majority of people suffer considerably more, as I have shown above, by slight pitching than by

much more severe rolling? In the cerebral cases pallor, giddiness, obscured vision, and other sensations precede the gastric phenomena, but my experience goes to prove that such cases are in the minority.

New modes of treatment are always cropping up, and each has its strenuous advocates; at one time Chapman's icebags to the spine, at other hot-water bottles to the feet and epigastrium. For my own part, I am certain that in severe retching and persistent sickness nothing is so trustworthy as a hypodermic injection of morphine. With this exception I never rely alone on one method of treatment, for even seasick patients have their idiosyncrasies.

The best advice I can give-in a few wordsto those who suffer principally from gastric phenomena is that before starting on a voyage they should provide themselves with a good flannel roller bandage twelve feet in length and six inches in breadth, and wind it round their trunk over the whole width of the abdominal region; this will frequently afford great comfort by preventing the contents of the viscera from undue movement. A few turns of a surgical bandage round the head also appear to allay a good deal of the accompanying headache.

DISLOCATION OF THE NINTH RIB.

S. G. HARRISON, M. D.

A young woman, aged about thirty, rather slightly built, came to me complaining of acute pain in the left side. Three or four days previously she had been putting up a big picture and this slipped suddenly, throwing all the weight on the left arm. She felt acute pain in the left side and thought she had strained herself. The next day she found the side swollen, so she rubbed in some embrocation and rested. Finding that the swelling went down but the pain did not subside she came to me. I found slight

swelling and some tenderness in the left side and acute pain on breathing deeply, and on examination I found that the cartilage of the ninth rib was dislocated at its junction with that of the eighth, and that the swelling and tenderness were in this situation. This is, I believe, a rare accident, particularly from indirect violence.

A CURIOUS METHOD OF OPIUM POISONING. J. A. HENTON WHITE, M. D.

At 11.30 P. M. on March 31 Mrs. Y. brought her baby, aged three months, saying that it was dying. The infant was very pale and cold; its pupils were minutely contracted, and it could with great difficulty be roused up. I inquired if any sleeping draught or soothing syrup had been administered, but this was denied. Mrs. Y., however, mentioned that she had put a pledget of cotton-wool soaked in laudanum in her tooth, which was aching during the evening. She was quite sure the baby had had none. Under the circumstances I washed out the baby's stomach, by means of a soft rubber catheter, with very weak Condy's fluid, and left in a drop of liquid extract of belladonna. I also gave small enemata of black coffee and roused up the infant. In about half an hour I sent it home, telling them to keep it warm but awake. They sent for me about I A. M., and I found the child awake, pupils very big, and skin rather flushed from the belladonna. I ordered a warm bath, and next day found the child quite well.

On questioning Mrs. Y. I ascertained that she was in the habit of moistening the teat of the baby's bottle in her mouth before giving it the child, as "it took to it better." She did not think she had done this more than twice or three

times during the time she had the laudanum in

her mouth. She was sure the child could have got the poison in no other way.

A REALLY CLEVER DOCTOR. The following advertisement appeared in a recent issue of an English paper:

Can any lady recommend a really clever doctor, for a confinement, whose fees are not high, in Chelsea or the immediate neighborhood? Address, Box

The lady who requires a "really clever doctor' to attend her in her confinement must be under the impression that "real cleverness" in a medical man is as easily detected by the lady who is attended by him as the "real goodness" of a "really good cook" is appreciated by her mistress. She has followed the form which she has