The local treatment is determined by the degree and location of the burn. To those of the first degree, about all that is necessary is to coat over the parts with some pasty substance, and some one of the following may be used: bicarbonate of soda, zinc oxide, bismuth subnitrate, etc., or even cold cream, sweet oil, and common lard.

When we come to treat burns of the second or third degree the indications are very different; and in the judgment of the writer it is of prime importance to render the parts thoroughly aseptic. A safe way to attain this in this particular class of cases is by using antisepsis, because we usually have to start with debris, which, if it is not completely gotten rid of, will serve as a nidus for infection.

It was my misfortune in the not very remote past, to get burned, and I think that I know something of the excruciating pain which accompanies these lesions, notwithstanding the fact that I had prompt and proper attention. And in the selection of appropriate local measures lies the all-important point of relieving the pain as completely as possible and keeping it thus relieved.

According to most authorities, and this has been my experience, picric acid, in a saturated aqueous solution, heads the list of local measures, because it is analgesic, antiseptic and keratogenous, three qualities very essential in the management of this class of troubles. It is best applied by saturating strips of gauze and applying it in successive layers, one upon another, until the entire surface burned is covered by several thicknesses, absorbent cotton applied, and a roller bandage placed over this, completes the dressing. This dressing should remain undisturbed so long as the patient does well.

Ichthyol probably holds the second place as a local measure, and it is usually applied as an ointment with vaselin or lanolin 20 to 25% strength, and gauze strips, absorbent cotton and a roller bandage completes this dressing. If suppuration occurs, an ointment compound of iodoform 10 grs., boracic acid and antipyrin of each 75 grs., vaselin q. s., gives very satisfactory results, but here the dressing must be changed often. Referring again to the effect of picric acid, it seems to produce a smoother cicatrix than other agents.

Among some of the most frequent complications are nephritis, gastritis, duodenal ulcer, pleurisy and pneumonia, and the last mentioned is by far the most frequent.

Rogers, who has studied the mechanism of death which supervenes within a few hours from burns, finds that complete siderosis of the nervous system has taken place, irritation of the nerve terminations having produced a series of inhibitory acts in the organism. The gases of the blood diminish markedly, and the asphyxia that is said to be produced by these blood changes is an arrest of metabolism, but not asphyxia.

I desire to close my paper with the question, Are we justifiable in using any of the numerous measures, many of which are both caustic and toxic, and which are frequently used, when we have at our command those of equal efficiency and which are void of these objectionable features?

HOSPITAL CARS FOR RAILWAY SERVICE.

BY G. B. THORNTON, M.D.
MEMPHIS, TENN.

Local Surgeon Memphis Division I. C. R. R.; Local Surgeon Memphis Division Southern R. R.; Ex-President Memphis Board of Health, etc.

In the April number of the International Journal of Surgery (N. Y.) there is an article on Hospital Cars for Railway Service by Dr. W. L. Estes, of South Bethlehem, Penn., Chief Surgeon of the Lehigh Valley R. R., with discussion of the paper by several railroad surgeons and comments by the editor, Dr. Geo. Chaffee, who also participated in the discussion, which would indicate that the paper was read before a meeting of railway surgeons, though it is not so stated. This, however, is immaterial, and this may be taken as part of the discussion of Dr. Estes' paper.

The subject is one well worthy of earnest consideration by all railroad officials who are directly or indirectly responsible for the proper care of sick and disabled employés, etc., of their companies. There is a double responsibility on all railway surgeons-first, that common to all surgeons, then as railroad. officials where the interests of the company may be involved

in a legal sense, and they may be called on to testify in suits against the company for alleged damages. Hence everything pertaining to the welfare of those they may be called on to treat is of interest to them in a strictly business sense. But in addition to these professional and business obligations there is a humane and philanthropic feature that should be considered. The important and constantly recurring duty of the proper transportation of the badly disabled from the place of injury to final destination, the company or contract hospital, is the subject of Dr. Estes' timely paper.

In the discussion that followed no one seemed to disagree with the general proposition, that is, as to the general desirability of transporting surgical cases in the most approved style from one point to another, but there was disagreement as to the practicability of acquiring and bringing into useful practical service at short notice an exclusive, or strictly speaking, hospital car, held in reserve for emergencies. The cost and equipment of this coach is estimated to be $2500 or $3000. The number of these cars, their proper location or distribution, and the expense of keeping them in commission for occasional service or emergencies, are all serious obstacles to this scheme.

As a local surgeon for more than fifteen years for two railroads, I have had considerable experience in both shipping and receiving railroad employés and passengers with a variety of injuries incident to railroad service. Also in the shipment or transfer of sick employés to their company hospitals, in one instance a hundred and sixty miles distant, or about five hours run for their fastest trains. This company hospital being at Paducah, Ky., about midway between Louisville and Memphis.

It is apparent that there should be better facilities for the removal of the sick and disabled from any point on the road with the least possible delay. To accomplish this there should be a compartment in one or more of the passenger coaches of every train, so constructed that a patient can be taken into it on a stretcher through a side door like that of a baggage or U. S. postal car, and placed on a cot or bed which can be closed up when not in use, after the manner of a berth in a

Pullman sleeper. This compartment should be sufficiently large to accommodate at least two such patients and have all necessary appliances and facilities for their proper care while in transit. It could be similar to the smoking or lounging room of the improved passenger or day coaches on the main lines. This would not necessitate the construction of new coaches, but only an inexpensive remodeling of those now in use; and when this room is not used for the sick or wounded it might be used for other purposes. But the main point is to have some place where these unfortunates may be temporarily cared for in comparative comfort. It should be made a part of the equipment of the transportation department, in order that when needed it might be most conveniently available at all points along the line of road.

Besides the utility of such an arrangement for the care of injured employés and passengers in emergency cases incident to railroad service, it would frequently be of service to citizens and patrons of the road who wish to be brought from the country or neighboring towns to one of the hospitals in the city for treatment or surgical operations which cannot be safely delayed, and who like the unfortunate railroad man have to be moved on a stretcher or cot. The only place at present for such an invalid during transit is the rough-moving baggage car, exposed to currents of air and other unavoidable discomforts, besides being in the way of the baggagemaster and his business.

The hospital car as described by Chief Surgeon Estes would doubtless be a splendid thing for the accommodation of a large number of injured people if available when wanted; but for the practical uses and frequent transport of individual cases the compartment car, which is one of the units of the twice or thrice daily train, is to be preferred. It is fair to assume that most if not all railway surgeons will agree that there is much to be done toward improving the transportation of sick and wounded, and this department of our work is far behind the advancements of modern surgery and modern hospital facilities.

Dr. Estes is to be congratulated upon his thesis, and it is to be hoped that the subject of better transport of the sick and

disabled of all railroads will soon be improved, which can be done at a nominal expense to the companies and but little additional care to the operatives.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.

Visiting Physician to St. Joseph's Hospital, Memphis.

Medical Treatment of Actinomycosis.

Sawyers (Jour. Am. Med. Assn., vol. 36, no. 19) presents a report of several cases of this disease, and believes that he has added some testimony to establish the following positions:

1. That actinomycosis is not an uncommon disease.

2. That, where pure, it is a non-suppurative, afebrile, comparatively painless, slow-progressing disease.

3. That the clinical signs and symptoms are often pathognomonic.

4. That the club-shaped bodies, single and in asters, are often absent, the threads more frequently present, and the coccus-like bodies most constantly present.

5. That combined surgical measures and the administration of the iodid of potash give the best results.

6. That iodid of potash administered internally cures a large percentage of cases. And, finally, that the interstitial injection of iodid of potash into the infected tissues exerts a strikingly salutary influence over the disease.

Rabies and the Preventive Treatment in Germany.

Ruhrah (Maryland Med. Jour., vol. 44, no. 5) says: The conclusions to be drawn from the experience in Germany are quite evident. In Prussia alone there is an evident increase in the disease in animals, with a consequent increase in the number of people bitten. In spite of this fact the mortality percentage has been definitely lowered. In the untreated cases during 1899 the percentage of deaths was 6.9%. In the treated cases the mortality is only 0.52%.