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Gunshot Wounds.

Legislation on the Marriage Question. Dr. Nicholas Senn thus sums up an ex- Quite a number of States already require haustive paper on the modern treatment a license to marry, and impose heavy of gunshot wounds in military practice: penalties on both minister and principals

1. In theory and practice military sur- for any irregularity in the matter of the gery is equivalent in every respect to emer application. gency practice in civil life.

The different commonwealths bave dif. 2. The wounded soldier is entitled to the ferent qualifications as to age, etc., but in same degree of immunity against infection every one of the States having such reguas persons in civil life suffering from simi- lations any inhabitant can secure a license lar injuries.

to marry regardless of mental, moral or 3. The fate of the wounded rests in the physical fitness to assume the duties of hands of the one who applies the first dress. paternity. Some, forsooth, require the coning.

sent of parents when children make appli4. The first dressing should be as simple cation for license; or in lieu of such conas possible, including an antiseptic powder sent accompanying the application when composed of boracic acid, four parts, sali- there is any doubt of the age of the parties cylic acid, one part, a small compress of in question, their affidavit is sufficient. cotton, safety pins and a piece of gauze The evils resulting from such an arrangeforty inches square.

ment are patent to all, and especially to 5. Any attempt to disinfect a wound those who personally view the operation of on the battlefield is impracticable.

such laws. To the intelligent listener in 6. The first dressing stations and the the average license court, the hum of field hospitals are the legitimate places voices making affidavit seems a weird and where the work of the hospital corps and ominous music. The syphilitic, venereal company bearers is to be revised and sup- wreck, consumptive and epileptic, the plemented. All formal operations must feeble-minded and the dipsomaniac stand be performed in the field hospitals where before the bar of the State, with a brand the wounded can receive the full benefits as plain as that of Cain upon their brow, of aseptic and antiseptic precautions. and asking, receive unchallenged, permis

7. Probing for bullets on the battlefield sion to legally procreate their tainted spemust be absolutely prohibited.

cies. 8. Elastic constriction for the arrest of The well-balanced mind reels with horhemorrhage must not be continued for ror at the spectacle, and already efforts more than four to six hours for fear of are being made to remedy the evil. Numcausing gangrene.

berless sacrifices must be made and years 9. The X-ray will prove a more valuable must elapse before even the medical prodiagnostic resource than the probe, in lo- fession comes to realize the enormity of cating bullets lodged in the body.

this crime against humanity ; but we can10. Gunshot wounds of the extremities not doubt that in due time popular opinmust be treated upon the most conserva- ion will crystallize into law that will tive plan, the indications for primary am- arrest the evil. putation being limited to cases in which The Paris Court of Appeals has decided injury of the soft parts, vessels and nerves that the fact of marrying while suffering suspend or seriously threaten the nutrition from any venereal disease is sufficient of the limb below the seat of injury. cause alone on which to grant a divorce.

11. Operative interference is indicated A bill is now before the German Reichstag in all penetrating gunshot wounds of the providing heavy penalties for the transskull.

mission of any venereal disease in any form 12. Gunshot wounds of the chest should manner whatsoever. The State of be treated by hermetically sealing the Texas prohibits the marriage of the epiwounds under the strictest aseptic precau- leptic, and bills have been introduced tions.

before the legislatures of Massachusetts, 13. Laparotomy in penetrating gunshot Ohio and Maryland prohibiting the grantwounds of the abdomen is indicated in all ing of licenses to marry to the syphilitic, cases where life is threatened by hemor- epileptic, feeble minded, dipsomaniac and rhage of visceral wounds and the general consumptive. condition of the patient is such as to sus- It is not expected that they will pass tain the expectation that he will survive these legislative bodies; the cup of sacrithe immediate effects of the operation. ficial blood is not yet full; youth, beauty

or

and innocence must still be legitimate Dr. David Riesman has found strontium prey for disease and lust, but the agitation bromid, in conjunction with massage, a will not cease till this enormous iniquity curative remedy with two obstinate cases is finally blotted out forever. -Charlotte of rheumatoid arthritis. Medical Journal.

The American Medical Review recom[The Senate of North Dakota has passt mends the following spray to be used a bill providing for a commission of three thrice daily for hay fever: An ounce each physicians in each county for the examina- of eucalyptol and glycerin, two drachms of tion of all applicants for marriage licenses.] laudanum, distilled water to make six

ounces. Dangers of Blisters.

A Point in the Differentiation between Dr. Huchard (Bull. de l'Acad. de Méd., Central and Peripheral Deafness.-Dench No. 7, 1898) states concerning blisters :

calls attention to the practical value of 1. They often produce an open wound

the fact that in disease of the perceptive which facilitates secondary infections or auditory apparatus the upper tone limit is the absorption of cantharides.

lowered; whereas in conductory disorders 2. Besides tending to cause inflammation

the lower range of the notes become inauof the kidneys and bladder, they have a

dible. general congestive action. 3. Even in those diseases where they

The Effects of Tobacco Smoke.—Pediaare most frequently used, such as pneumo

trics enumerates the following: Diminunia and pleurisy, they could be discarded, tion and deterioration of the red blood as they induce pulmonary congestion.

corpuscles ; functional irregularity of the 4. Blisters tend to arrest excretion by heart; impairment of sight and of accomthe kidneys, so important in all infectious modation; salivary over-secretion, prodiseases, and this is especially harmful in ducing dyspepsia and loss of appetite; those normally causing albuminuria. pneumokoniosis ; in extreme cases paraly- . Instead of aiding the excretion of toxins, sis and convulsions. blisters are likely to produce a fresh intoxication.

Spyhilis-How Shall We Stop its Alarming 5. The only real use of blisters is in their

Spread? revulsive and analgesic action, but the Syphilis, one of the oldest and one of the effect is better attained by less dangerous greatest curses of mankind, has steadily means, such as mustard plaster or cold gathered new victims, and now at this late baths.-Gaillard's Medical Journal. day, the great syphilolographers of the

world are to meet at Brussels, Belgium, to Oil of mustard has been applied with devise some means by which to check its success to the anus as a “keep-awake rem- alarming spread. edy" in opium narcosis.

The history of syphilis is a most appallSudden giving away of the legs while ing acknowledgment of gross disregard of walking is a symptom worthy of remem

its serious nature, and an unpardonable brance as an early sign in some cases of delay in a systematic and continual warlocomotor ataxia.

sare against its propagation. It shows Heller, of the Philadelphia Polyclinic,

that the disease is most extensively met has found the addition of small doses of with in large cities in the very heart of arsenic very efficacious to prevent drug

civilization, and has on its muster roll not eruptions.

only the prostitute and the habitue of the For the nausea that so often follows the higher intellectual sphere; that it does

slums, but the aristocrat and those of the use of opium or morphine, Garrod says

not visit its wrath exclusively upon those nothing is better than coffee, or caffeine,

who wilfully subject themselves to the tea or saline aperients.

danger, but also upon the innocent, for its Dr. Fruitnight (Archives of Pediatrics, mode of infection is not limited to direct August, 1897), states that recurrent epi- venereal contact, but on the contrary, all staxis in children is frequently significant objects which come in contact with the of organic heart disease.

secretions of the mouth of a syphilitic In all forms of congestion and inflam- may be the means of its transference from mation of rectum, hot water enemata, med- one person to many others, and that even icated or otherwise, are indicated for their infants may, thru the medium of the soothing and depletant effect.

nurse, fall victims to this dread disease.

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THE MEDICAL WORLD: 4 Notwithstanding this awful history,whose viewing this condition in a more serious pages increase in numbers with each suc- light. Strike at their freedom and you ceeding year, the world has seen fit to sit will gain their co-operation, for they will practically unconcerned and watch the look upon syphilis as being something far disease spread, and the medical profession, more serious than a skin disease, and rewith the exception of the syphilolograph- gard the probability of infecting others as ers, has taken but scant interest in efforts worthy of consideration. Reckless of to check it.

their health, devoid of any feeling for Effort to check the spread of syphilis is their fellow-being, they are jealous of their more the duty of the law than medicine. liberty and, as do all criminal classes, enThe physician has learned its origin, its tertain the profoundest respect and fear nature and its treatment; he, from his for the law. position, can give no plan other than offer The law must make a stern and relentsuggestions which must be accepted and less crusade against the syphilitic, strikacted upon by our legislative bodies. So ing first at the prostitute, and where far, legislation in relation to syphilis has found, forcing her to a place of confinebeen of but little benefit on account of the ment, where she can be kept under proper impracticability of the laws passt.

treatment until free from possibility of Houses of prostitution are the most vir- infecting others. It is a well-known fact alent centers, and the first blow must be that but few of these will take the proper struck at them. The total abolition of treatment long enough to do much good, prostitution, tho devoutly to be wisht, is, and it is very essential, to the accomplishat the present day, beyond the hope of ment of our purpose, that some place be man, and attempts which have been made established to which syphilitics may be towards accomplishing such an end pre- sent. We have the Isle of Molokai for sent thruout centuries an uninterrupted the leper, why not find some such place series of defeats, for the sexual passions, for the syphilitic? The mere existence of the strongest impulse of human nature, such a place will have a greater moral efhas invariably asserted itself, and other fect than all the pulpit oratory and clinical laws have been violated ; seduction, crim- teaching of the world combined. The inal abortion, illegitimacy and infanati- search must extend beyond the bagnio, cide, with impairment of morality, have and find those men, "The Rounders,” followed the experiment.

who are ever a source of infection for the Inspection of prostitutes by medical ex- prostitute ; these also must be forced to aminers has been enforced in many cities, take treatment which will relieve all and as often as it has been tried it bas danger of their spreading the disease. proven a failure; for as everyone knows, To be successful, the strong arm of the who possesses any knowledge of venereal law must strike wherever syphilis exists, diseases, it is folly to believe it possible to and should even enter the church, and prevent the danger of infection by weekly strike at hyman's altar, not permitting examinations of the prostitutes of a city, any man known to be syphilitic, to emas the inspector may find the woman free brace in connubial bliss, the pure and from disease on the day of inspection, only healthy girl whom he wishes to make his to have it appear during the interum; wife. The marriage certificate should furthermore, it is not always possible to carry with it a clear bill of health, which detect the primary lesion of syphilis, and should be the cardinal clause in its rein consequence of these facts the system quirements. is rather more of a danger than a safe- It may be said by some that such interguard, for many young men, thru a false ference with the liberty of the individual sense of security, on learning that the is illegal; yet we claim that the State has prostitute possesses a certificate of health, the right to protect the health of its citi. will indulge in the sexual act when other. zens by every avaible means. wise they would not.

antine laws against yellow fever, smallLaws must be passt of so rigid a nature' pox, etc., interfere with individual libas to force the prostitute, thru fear, to erty, and the should apply to place a higher value on her health, and syphilis, which, while not so dangerous to when the fight is once begun it must be life, is still a terrible menace to health, persistently carried on with sufficient vig- and on account of it being, as it were, a ilance and energy to accomplish good re- concealed danger, with many modes of insults, by alarming the prostitute into fection, it is greatly to be dreaded. Why

Our quar

same

should we hesitate to make open and re- applied to the legitimate use of alcohol in lentless war upon these women who, lost pharmaceutical manufacturing met with to all sense of morality, and so long per- the unanimous indorsement of those parmitted to practice their nefarious occupa- ticipating in the discussion. This scheme tion, unmolested by the law, unnoticed by of substituting acetic acid for alcohol as a sanitarians, feeling no concern as regards menstruum bas long been advocated by the danger of their sexual companion, and Dr. Squibb, but it will meet with but little who stand an awful menace to our young favor in the medical profession.—Gaillard's men and an indirect cause of untold suf Medical Journal. fering to the pure women of society, and the origin of a hereditary taint, which

At the recent examination of candidates follows thruout generations, when we im- by the New York State Board, there were prison the poor wretch who steals a loaf 123 applicants, of which 94 were successful. to keep off hunger? Is it a greater crime to pick a pocket than to steal your health, University of the State of New York-Medical and that of your wife and your offspring ?

Examination. The laity must be told the unvarnisht

[From the Med. Review of Reviews (rearranged).] truth, and warned of the many dangers of infection. The mock modesty of the law

QUESTIONS IN SURGERY. maker, and the unsound religion of the 1. Explain the preparation and preserpulpit must be changed. Prostitution, vation of animal ligatures and sutures. tho in a sense greatly to be deplored is, in Answer : By preparation and preservaa way, absolutely essential ; it snyuld be tion of ligatures and sutuses, we mean under control of the law and kept clean their sterilization. The processes emas possible.-Louisville Med. Jour.

ployed vary with the material, as follows:

Catgut, soak in ether 24 hours to remove Alcohol Versus Acetic Acid.

the fat; with sterile hands wind it on clean At a recent meeting of the New York glass spools, and boil it in alcohol 1 hour; State Medical Association, Dr. E. R. Squibb store in boiled absolute alcohol in sterilized said that it might be of interest to learn glass vessel. of the work being done in the way of re- Chromicized catgut, soak for 48 hours, tiring alcohol as a menstruum for exhaust- 200 parts, by weight, of the gut in a mixting drugs. A good deal has been accom- ure of carbolic acid 200 parts, boiled water plisht in this direction in the last two or 2,000 parts, and chromic acid 1 part. It three years. Of the other menstrua experi- is then boiled in alcohol, and stored as mented with up to the present time, that above. which had given the best results was acetic Silkworm gut is simply boiled in alcohol acid in various strengths. It had been 1 hour, and stored in boiled absolute discovered that a ten per-cent. solution of alcohol. acetic acid was almost universal in its ex- 2. Describe an operation for the radical hausting powers. There were now in use cure of bunions, in veterinary practice and in some hospi- Answer: After all aseptic preparations, tals, extracts made with acetic acid. They a free incision is made on the inner side were made according to the requirements of the joint, any excessive inflammatory of Pharmacopea except that acetic acid tissue removed, and enuf of the base of the was substituted for alcohol. Acetic acid first phalanx removed so that the toe can when used with alkaloids gave the physi- be brought into its normal position, and, cians certain advantages in prescribing, while held in place during healing, bony owing to there being fewer incompatibles. ankylosis shall not result. The dressing In small doses the percentage of acetic of the wound, temporary and subsequent, acid in the extract was so small as to be follows the special indications, as to preshardly appreciable, and when larger doses ance or absence of pus, etc., as in any were required the acetic acid could be operation. neutralized by the addition of potash or 3. Give the procedure for producing cosoda. In commenting on Dr. Squibb's cain anesthesia during the removal of a statements, Dr. H. D. Didama, of Syra- small tumor of the skin. cuse, said that it did not seem to him that Answer : Use a 2 per cent. solution of cothe use of alcohol by the profession had cain hydrate in a clean hypodermic needle. been abandoned, either socially or other- After the skin has been sterilized inject a vise, a view of the case which so far as it few drops just under the surface, stopping when blanching appears. After withdraw- 6. Give the etiology, diagnosis and treating the needle reinsert farther on where ment of chronic blennorrhea of the lachthe blanching has already occurred, and rymal passages. advance it little at a time, injecting the Answer: Chronic blennorrhea of the lachsolution drop by drop in what is to be the rymal passages is almost always secondary line of incision. If the tumor is in a pend- to inflammations of (a) the nasal mucous ant portion, a ligature applied so as to membrane or bone; (b) or of the eyelids. retard the circulation in the part will serve Of these, various causes-e. g., chronic to render the anesthesia more prolonged. catarrh, the exanthemata, syphilis, in the

4. Describe morbus coxarius and give its former class; blepharitis, ciliaris, trachoma, treatment.

or most frequently conjunctivitis, in the Answer : Tubercular disease of the hip latter. Another factor is often any objoint produces chronic suppuration with struction in the lumen of the passage. the formation of fistulas and necrosis, or The disease is very rarely primary, due plastic effusion with ankylosis. Symp- to traumatism or other irritation. toms: Pain, often in paroxysms, at night, Diagnosis.-Made by noting the possiand referred often to the knee; muscularble causes, the locality of ihe swelling atrophy, rigidity and contraction produc- firmly situated behind the palpebral ligaing deformity; stiffness of the joint, and ment by pressure upon which a muco-purspinal curvature.

ulent secretion mixt with tears is evacuTreatment. Extension during acute ated from the canaliculi. The skin is movsymptoms, followed by immobilizing appa- able over the tumor. ratus. Aspiration of or free incision into Treatment.–First. Against the cause. the joint, if the collection of pus is great. Second. Favor relaxation of the distended Sometimes excision of the joint or division sac by slitting one of the canaliculi and of the bone, to correct deformity.

subsequently probing the Dasal duct. 5. Give the indications for amputation Third. In resistant old cases a portion of in compound fracture of the thigh. De- the wall of the sac is to be excised that scribe the operation and its details. the secretions may not be so readily re

Answer: (1) Such crushing of the limb tained. as to amount to avulsion, or when the parts 7. Describe two methods of sterilization are so lacerated as to render restoration of of the skin. their life impossible.

Answer: For sterilizing the skin one (2) When the blood-vessels are de- method is to simply wash it thoroly with stroyed, cutting off the nourishment so green soap and water, shave if necessary, that gangrene certainly will or has already and wash with bichlorid solution i to developt.

1,000 and then with alcohol and ether. (3) Destructive disease of the bone su- A better method twenty-four hours bepervening upon an unuited fracture. fore operation : Wash the surface and ap

The operation.-Preliminary antiseptic ply green soap poultice for twelve hours. and aseptic preparations as usual. In gen- Substitute wet bichlorid (1 to 5,000) eral the operation is one of a long anterior dressing which is to be removed only after and a short posterior flap, with the bone the patient is on the table. Then wash divided some distance higher up. In de- with ether followed by bichlorid or chlotail, after the blood supply bas been cut rin water. off by an Esmarch bandage an incision 8. Differentiate fibrous union from nonthru the skin marks out the anterior union following fracture of the shaft of the flap, in length one-third, and in width at humerus. the base almost two-thirds the circumfer- Answer: Fibrous union is where the ends ence of the limb. The muscles are then dis of the fractured bones are united by fibrous vided upward and backward, making the tissue-not calcified and therefore allowflap not too thick. The posterior segment ing some false motion. of the limb is divided transversely, the Non-union means that the ends of bone bone cleared and divided an inch or two have failed altogether to unite. higher up and its anterior edge beveled. 9. Describe an operation for circumThe flaps are then brought together and cision. sutured, drainage being inserted first after Answer: Cleanse the part thoroly. Catch the blood-vessels have all been caught and the foreskin in a clamp ahead of the glans ligatured. The usual aseptic dressing is and cut off the redundant portion. Rethen applied.

move clamp and make dorsal incision in

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