CASES FROM PRACTICE.

NOTES OF DISPENSARY CASES.1

BY F. T. OUTLEY, M. D., ST. LOUIS

CASE I.-ABSCESS AND GANGRENE OF HAND.

B. F. (col.), age 44, came to the dispensary Feb. 12, with abscess of left hand and gangrene of thumb. About five weeks before he had run a splinter into his thumb, under the nail; his wife succeeded in removing a portion of the wood, and a surgeon who saw it later also removed a small portion. When he presented himself here the hand was very much swollen, and the gangrene involved the first joint of the thumb. Deep incisions were made into the hand on dorsal and palmar surfaces, releasing large quantities of pus, and he was advised to poultice the hand. In the course of several days, he coming every other day, the line of demarcation appeared, and he refusing to go to the hospital, being a married man with large family, we amputated, removing the head of sec. ond phalanx, leaving lateral flaps. The wound healed by granu

lation and he made a good recovery.

CASE II.-GAangrene of Finger.

E. J., age 28. Laborer, came to dispensary May 10. While under the influence of liquor, attempted to up-end a barrel of oil. The fingers of his left hand were caught between the chine and a large rock, lacerating and fracturing the second phalanges of first and second fingers. Dressed antiseptically and sent home. He continued to drink, and gangrene of first finger ensued. Amputation followed, rounding off the bone of second phalanx. He was given

iron and quinia in small doses and made a good recovery.

1. We are indebted to Dr. F. T. Outley, assistant city dispensary physician, for the account of the following cases, and to the gentlemen of the City Hospital staff for the continued history after the patients were admitted to the hospital.

CASE III.-LACERATED AND CONTUSED WOUND OF THE HAND. J. H., age 16, St. Louis, paper hanger, came to the dispensary on Tuesday, March 29, having received a lacerated and contused wound of all the fingers of the right hand.

The patient received his injuries by an accident with a putty machine. The wounds made were the result of crushing, and in detail were as follows:

Third phalanx of little finger with all of its coverings was completely removed. The end of the index finger and about one-third of the middle and ring fingers were simply hanging, attached by some tendons or fascia. Wound of index finger is at second phalangeal joint, that of the two middle fingers just beyond first phalangeal articulation. Bones are broken in each instance. Distal ends of injured fingers are of waxy paleness, cold and without sensation. There was but little bleeding. Rounded off exposed end of phalanx of little finger, sewed on the severed ends of the other injured fingers by means of deep continuous silk suture. The attempt at securing union was made almost without hope of success, yet there was nothing to lose by the attempt; even in point of time. This course was adopted by Dr. Shattinger after consultation with Dr. Lewis. Hand and fingers had previously been cleansed and were again thoroughly washed with antiseptic solutions. Dressed with iodoform, antiseptic gauze, plenty of cotton and antiseptic crinoline bandages. Enveloped all in rubber tissue to retain warmth and placed hand and fingers on anterior splint.

April 1, Dr. McCune removed the dressing and found the fourth finger appearing gangrenous, the third and second looked as if they might be saved. A fresh antiseptic dressing was applied. The patient went out on that day with his father.

The highest temperature reached was 38° C. (100.4° F.) on the evening of the day following the accident.

THE AMERICAN OTOLOGICAL SOCIETY held its twentieth annual meeting at the Pequot House, New London, Conn., July 19, 1887. The following are the officers for the current year: President, Dr. J. S. Prout, Brooklyn, Vice-president, Dr. Geo. C. Harlan, Philadelphia; Secretary and Treasurer, J. J. B. Vermyne, New Bedford, Mass. The next meeting will be held at the same place on the third Tuesday of July, 1888.

EDITORIAL.

HYGIENE OF THE POLICE FORCE.

In a paper read before the section in State Medicine at the meeting of the A. M. A. at Chicago, Dr. Geo. Homan, of St. Louis, presented the result, of some careful observations which he has made during two years in which he has served as Medical Examiner to the Police Department of this city.

In the examination of nearly five hundred patrolmen he found the average mean girth of the chest at the level of one inch above the nipples was a trifle more than thirty-eight inches, the extremes being the measurements on forced expiration and inspiration. Measurements were made with a steel line upon the bare skin. The average expansibility of the chest was 2.759 inches. The average stature was 5 ft. 8.22 in., weight 167.36 pounds, average waist girth 34.131 in.

Examination of mortality and morbility records showed that pulmonary affections hold a leading place among the causes of police disability.

In the endeavor to determine the relation between the mode of life and work of the police patrolmen and this noticeable tendency to pulmonary disease, with its accompanying necessary impairment of efficiency, he remarks first;

The daily routine duty required of a patrolman in this city is twelve hours' service out of the twenty-four, extending from 11 A. M. or P. M. as the case may be, the change from day work to night work, and vice versa being made every three months. Aside from one hours' drill per week in the manual of arms during the winter months, no bodily or athletic exercise is required of a police

man other than that involved in patrolling the district assigned to him, with the incidental exertions needed on his part to maintain law and order therein; the result being that there is usually plentiful foot and leg exercise to the neglect of other highly important parts of the body.

Comparing the measurements of the members of the force with those of 122 new recruits he found the latter to measure about one-quarter of an inch more in chest girth and the average chest expansion of the new recruits to be 3.395 in. to 2.759 inches given above as the average expansion of members of the force. This latter measurement is of far greater significance than the former, as Dr. Homan well remarks, because "a considerable gain in mean chest girth may be noted while the absolute breathing capacity of the chest cavity, and free play of its walls are diminished."

As the result of his observations Dr. Homan draws some conclusions regarding the importance of systematic gymnastic exercise for men engaged in such work as are the patrolmen of a city police force, which are equally worth consideration by those who have any responsibility in promoting the efficiency and reliability of a fire department or a salvage corps.

In order that the members of a fire department or a salvage corps may be at all times ready to respond to the demand for extraordinary and sometimes prolonged exertion, for which they may at any time be called upon, they should not only have opportunity but should be required to take regular, systematic exercise, not se. vere or overtaxing the muscles, but sufficient to secure and maintain thorough development and the most perfect nutrition,

We would commend to the consideration of our readers the following paragraphs from Dr. Homan's paper:

"Additions to the regular force are usually made from among men employed as laborers, mechanics, porters, teamsters, and like occupations in which the muscles of the arms and associated parts are brought into more or less constant vigorous exercise. Upon assignment to police duty the accustomed symmetrical use of all the

working muscles is lost, as compared with theprevious occupation, walking being all that is required of the officer, and the hurtful effect of the change, after the lapse of a few months even, upon pulmonary expansibility and capacity is most marked. In repeated instances applicants for appointment coming from occupations requiring all-around exercise, and in whom the respiratory apparatus was found to be of superior excellence as regards both free expansibility and normal breathing sounds, after six months police service the normal expansion had decreased from one-half to one inch, or even more, and the comparative rigidity of the chest walls was accompanied by impaired or roughened vesicular murmur, with symptoms of circumscribed congestion, incipient catarrhs, and other signs of sluggish pulmonic circulation,-the girth of the chest being usually not sensibly changed.

This condition was so uniformly present in those cases in which the subject had resorted to no gymnastic exercise to maintain the initial good condition of the chest, as to at once attract my attention, and the good results that have followed the employment of means to increase the capacity of the chest, to develop and strengthen the auxiliary muscles of respiration, and to favor the free play, suppleness, and expansibility of the chest walls have been equally manifest. These results have appeared not only in a betterment of chest measure, but in the appearance and establishment of normal respiratory sounds, in increased freedom from coughs and colds, in improved general circulation, in appetite, digestion, nutrition and excretion-in a word there was a general exaltation of physical vigor and power that was consciously felt and enjoyed by the subject.

In instances where the applicant fell short of the standard through pulmonary defect remediable in character, the counsel given by me to overcome the difficulty has been followed for some months with the constant result of improvement in wind, and deepening of respiratory capacity. The means recommended to this end have been the systematic judicious use of hand weights,