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 |   Related post: increased, but rather diminished. E. F. SURGERY. Results of Ovariotomy before and after Antiseptics. By T. Keith, F. R. C. S., Edinburgh. — In a summary of his experience, published in the " British Medical Journal," Dr. Keith states that he was first convinced of the value of antiseptic treatment ten or twelve years ago, when shown by Mr. Lister a living blood-clot in the wound of a compound fracture. In what he calls the early days of antiseptics — 1869-'71 — a solution of carbolic acid was used freely in washing out the peritoneal cavity ; all the ligatures and instruments were carbolized ; towels soaked in the solution were held against the wound to keep the air pure that entered ; the walls even of the room in which the operation was performed were sponged with it ; in fact, carbolic acid was wasted in every way, and nothing but disappointment followed. For the next five years he made use of no antiseptics in ovariotomy, though continuing to do so in other operations. He still believed in the principle, but thought it better to trust to care and cleanliness alone. There was no preparatory treatment, save the giving of a cathartic. Few restrictions were put upon visitors. He freely exposed the abdominal cavity, cleaned it thoroughly, and there was no haste in closing. All oozing parts were secured either by Lister's ligatures or by the cautery. The cautery gradually displaced the clamp, or, when ligatures were re- quired, he used fine iron wire or catgut. He thinks he was fortunate in having discarded the use of silk, judging from Mr. Wells's one hundred and fifty-seven cases, in which silk was used, and of which sixty died, whereas, in fifty cases of his own, where the cautery was used, only four died. In severe operations it was his rule to use the drainage-tube, ex- tending to the bottom of the pelvis. Since 1876 he has operated with all Mr. Lister's care, and under the 328 REPORTS ON THE PROGRESS OF MEDICINE. carbolic-acid cloud, and declares that he shall never go back to the old way. Before giving his impressions of ovariotomy under the spray, he shows- what he has been able to accomplish by carefulness alone. He does not consider it a difficult operation, but one that requires care, and, in bad cases, time. He first operated sixteen years ago. Of his first one hundred cases he lost seventeen. During the live years preceding the use of spray he operated ninety-four times. Of these cases nine died : three from ma- lignant disease, one from obstructed intestine, and one from old kidney disease. He considers his good results due, 1, to drainage in severe cases by a large perforated glass tube going Buy Abana Online to the bottom of the pelvic cavity ; 2, to the use of the cautery in dividing the pedicle ; 3, to the use of Koe- berle's compression forceps in large numbers ; 4, to the substitution of ether for chloroform in his last two hundred and thirty operations. Of these, drainage and the cautery contributed most. He has performed forty-nine operations under the spray. Two of the first eight died, the remaining forty-one recovered. At first, relying too much upon the spray, he performed his operations rather more hurriedly, did not sponge so carefully, and did not secure every bleeding point. He gave up the drainage-tube. He is now convinced that, even with the spray, it is advisable to use all carefulness, and always to use the drainage- tube in severe cases. Then follows a comprehensive table of the cases where the spray was used. He uses Gardner's instrument, with the double spray producer. He is very positive about the necessity of using the spray, and says it is essential to the perfect carrying out of Mr. Lister's principle. He thinks that the clamp must give way to some intra-peritoneal method of treating the pedicle. His best results were after the use of the cautery. "What has ovariotomy gained from antiseptics? 1. It has lessened the mortality. 2. The increased Purchase Abana Online safety will induce surgeons to recommend earlier operations. 3. The drainage-tube will not be so often required. No one has practiced drainage so much as he, yet he knows well that it sometimes can not be used without risk. 4. Convalescence is rendered easier. 5. Antiseptics are a great comfort and relief to the operator. He does not mean at the time of the operation, but in the feeling of confidence and security it affords in regard to the safety of the patient. Drawbacks may yet appear. He had noticed great depression follow- ing long operations Buy Cheap Abana under the spray, and the greater stimulation that was necessary for the first twelve or twenty-four hours. The pleasure in the operation is marred by the frequency with which malignant disease is found at the time of operation or makes its appear- ance soon after. One fourth of his deaths were from malignant disease. Some who went home cured and apparently in excellent health developed cancer after some months. He pays a deserved tribute to Dr. Foulis for his investigations of the anatomy of the ovary, which have made its pathology simple, and enabled us to recognize healthy and malignant ovarian structure, simple ovarian and peritoneal fluids, as well as those of the uterine fibro-eysts. Ho considers this long-despised operation the Bafesl of all the great BUrgical operations, and closes with a tribute to Mr. Lister. On the Effect of Superficial Cauterizations of the Pharynx in Certain Veuroses. ("Allg. Med.Oentr. Zeit.," "Med.-Chir. Centralbl.," 1878.) Bitot emphaztaes the favorable effect of these cauterizations of the pharyngeal mucous membrane in cases of cranial neuroses with amnesia, due to affee- SURGERY. 329 tions of tlie superior cervical ganglion of the sympathetic. His conclu- sions are: 1. The head is the seat of certain nervous derangements whose localization lias not yet been determined. 2. In these the cranial portion of the sympathetic must participate. 3. The assumption is justifiable that the superior cervical ganglion of the sympathetic, which forms the chief seat of the derangement, is the starting-point. 4. When this neurotic con- dition resists the usual therapeutic measures, the relations of this ganglion to the pharyngeal mucous membrane make the latter especially adapted to counter-irritation. 5. The application of iodine to this mucous membrane has furnished remarkably favorable results in essentially nervous derange- ment; on the other hand, it is inert in the consecutive phenomena of apoplexy. 6. Under this treatment, many of the cases complicated with amnesia have regained the power of memory. E. F. Luxation of Inner Extremity of Clavicle forward and upicard. — Van- verts ("Gaz. des Hopitaux ") reports a further case of this rare disloca- tion. A man, sixty-nine years old, in falling struck against a stove with the right half of his thorax. Seen by the author immediately after the accident, he complained of severe pain in the region of the fourth and fifth ribs external to the nipple. Respiration was short, intermittent, and ac- companied by pleurodynia ; intense pain on moving the arm. The internal extremity of the left clavicle was markedly projected forward. The pa- tient being very emaciated, the entire articular facet could be felt. Judg- ing from the false point of motion, which was not that of a fracture, it seemed that the inter-articular cartilage had followed the facet. The most remarkable point, however, was the projection of the luxated por- tion upward, the clavicle projecting two to three centimetres above the sternum. The face was slightly turned toward the right, the head in- clined toward the left shoulder. Contrary to the statement of surgeons, that dislocations of the clavicle are easily reducible, the author states that he and other colleagues could not accomplish reduction (forcibly drawing the shoulder back and depressing the luxated end) attempted on repeated occasions. Anaesthesia was Order Abana Online not employed. — Buy Abana (Supplement " Med.-Chir. Centralblatt," 1878.) E. F. EsmarcKs Bandage in Diseases of the Extremities. (" Berl. klin. Wochen- schr.," "Med.-Chir. Centralbl.") — Cohn has employed the bandage for the purpose of absorbing inflammatory and other morbid products in the ex- tremities. Three cases of interest are reported. Two of these were of acute nature, in which, on account of the rapid improvement, the treat- Related links: Etodolac 500mg, Buy Analgin, Buy Cefixime Online, Zestril Cost, Purchase Salbutamol Online, Order Esomeprazole Online, cheap retin a gel, Lisinopril-Hctz Price, Levothyroxine Levothroid, Voltaren For Sale
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