1898 Journal of the American Medical Association (JAMA)  
dent. Others aver that we are not surgeons if we do not mutilate. This opinion, however, is of no importance when we are conscious of having done our best. It is the better plan to preserve all we can of an injured organism, even at the risk of retaining, for a time at least, that which may ultimately be an encumbrance. I have had cases when it seemed that to preserve an injured member would be useless or a nuisance to the jjatient. Nevertheless I have, as an almost invariable rule, suggested
more » ... e rule, suggested preservation and results have more than fulfilled my hopes. Among others, I remember the case of J. Griffin, a locomotive engineer, who had his left elbow crushed. The wound showed a comminuted, compound fracture of the upper epiphysis of the radius and cubit, and lower part of the humerus. Splinters of bone showed through and were extracted from the skin. My colleagues proposed amputation, but I succeeded in having it deferred until it should become absolutely necessary. Such necessity never occurred, for with proper antiseptic treatment, and infrequent, dry dressings the arm was saved, and, later on, the patient became known as one of the most efficient engineers on the road. In my thesis on soliciting admission to the National Academy of Medicine of Mexico, I referred to the case of an articular gunshot wound. The larger portion of the bullet lodged in the tibio-astragaloid articulation, and the smaller fraction in the soft parts in front of the same articulation. The wound was infected by pieces of sock driven in by the bullet. Yet, at the proper time I extracted the bullet and the patient entirely recovered the use of his feet. I could cite many other cases of similar nature, but I think it will be sufficient to state, that since the year 1888, when I entered the service of the Mexican International Railroad, the only amputations I have been obliged to make have been one forearm at the lower third, one foot at the metatarsus and two fingers. There is nothing so easy as to thoroughly clean a wound and the surrounding skin. In the case of train and shop men, it is often unnecessary for the washing process to be extra thorough if the skin has been stained with lubricating oil, because, although I have had no opportunity to make a bacteriologic examination of that substance, it is my impression that it has aseptic qualtities, since in nine years practice I have yet to detect a case of poisoning from contact with black oil. Possibly its aseptic qualities are due to its having been subjected for a long time, to heat caused by friction in the machinery. The washing I have mentioned, can be followed by hemostatic treatment, and then cover the bloody surface and fill in the interstices with an antiseptic salve, such as iodoform or salol 5 grams, antipyrin and borate of soda, each 1 gram, and vaselin 30 grams. This has an advantage over powdered iodoform, in that it prevents the gauze and cotton, which complete the dressing, from adhering to the wound, and causing, on their removal, not only considerable pain to the patient, but also tearing of soft tissues and consequent delay in healing. A crushed member can be kept dressed in this manner for fifteen days or more, if no indications appear that the dressing should be removed. This seldom happens, because the flaps, which may become affected with gangrene, are surrounded by an antiseptic salve which prevents their infecting other parts of the wound. Many of these diseased flaps, which we considered impossible to preserve, surprise us, not only by living, but adhering properly, if we have correctly placed them. Then we may not have to intervene, and if we are obliged to do so, we will find the patient in a better condition, and no longer under the influence of the shock. Before wrapping up the member, we have to remove its extremity if it is only held by a few tendons or a flap of skin or muscle insufficient for nutrition: If we find a stump with a tendency to assume a conical shape we will have to trim it, but all this can be done without risk. Dr. Paul Reclus, in an able article on the subject, published last year in the Revue de Chirurgie, advises the use of bichlorid of mercury and carbolic acid, in small quantities, in addition to the antiseptic salve, and the insertion of gauze in all the spaces. This last suggestion appears very appropriate in cases of large crushed wounds. He ends by saying, "henceforth we shall have no traumatic amputations." In preserving instead of amputating an injured member, we do a more humane duty, and accomplish a practical purpose. We save the company we work for from payment of a heavy indemnity. Twenty-eight years ago a great industrial revolution occurred in Japan. It was nothing less than a total change in the ancient vehicles employed in the transportation of passengers. Wheeled carriages had seldom or never been used before this. A few officials rode on horseback. The usual plan was for the poor to go on foot and the rich to hire coolies who carried them litter-fashion in sedan chairs and cagos. The cago was a kind of litter suspended to a pole and carried on the shoulders of two coolies. As this is very exhausting labor each coolie carried also a stick as long as from his shoulder to the ground. When they found it necessary to rest they set these sticks upright under the ends of the pole, thus relieving them from the weight. Men of means traveling to a distant destination hired four or six coolies, who relieved each other from time to time. This laborious mode of travel went on for ages. In 1870, twenty-eight years ago, an ingenious man in the city of Tokio discovered the fact that coolies can draw about six times as much weight on a pair of light wheels as they can carry in a cago, besides traveling at twice the speed. This was an astounding discovery in Japan, and the author of it forthwith invented the famous vehicle called the jinrikisha. Jin means man, riki is power and sha is a carriage, literally the man-power-carriage. The Americans in Japan jocosely call it the "Pull-man-car." It is simply a small chaise with light wheels about forty inches in diameter and drawn by shafts, between which a coolie stations himself instead of a horse. Seizing the shafts he trots off from four to six miles an hour. A fair ordinary day's work is a little less than twenty miles, but in emergencies they will do more.
doi:10.1001/jama.1898.72440760017002c fatcat:qpqsylbmwvd33nfghg6h3q7xc4