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tissues about were so twisted out of shape as to leave them to separate. But if the intraperitoneal method were to be adopted, it was necessary to control hemorrhage, do an aseptic operation, and drain through the posterior cul-de-sac into the vagina. Methods and Material in Abdominal and Pelvic Sur- gery. — Dr. Joseph Price, of Philadelphia, read a paper with this title. It was composed largely of surgical moral epigrams. The openings were many and wide for differ- ence of opinion. Ours was a great universe, in which we were all pupils, gaining with a humiliating tardiness the lessons of our science. We were not so tied to our pres- ent methods that we would not welcome better ones. The responsibilities of our ])rofession were too grave, our work, when wisely and skilfully done, too naprosyn 500 mg oral tablet beneficent in its character, for us to go on repeating errors. There was no time when we uere so hapj )y in' being at home as when our critics called. New and powerful impulses were car- rying forward the profession. Reverence for antiquated methods had lost its force, ^\'e accepted only those facts which withstood the severest clinical tests. To elicit discussion, Dr. Price gave his opininn upon some disputed points. Some, briefly stated, were the following : Vaginal hysterectomy for diseased appendages was a naproxen 500mg generic naprosyn very imperfect and dangerous procedure in the hands of every one. The adhesions, omental and intesti- nal, commonly found in the removal of all adherent forms of disease, must be dealt with from above. Hyster- ectomy for metritis and for prolapsus was unjustifiable. In cases of peritonitis, treatment must be naprosyn sr 1000 mg prompt, radical, and thorough. Seek the cause ; the abdomen once open, there should be no hesitation in removing it ; then establish drainage. Opium should be absolutely avoided. The one saving method of any variety of general peritonitis was abdomi- nal section and irrigation. Many lives had thus been saved. Leave no operation incomplete. Close holes into the intestine, should they be made during breaking up of adhesion. ■ Pain after operation was likely to be due to distention. 26 MEDICAL RECORD. [July I, 1893 Give salines before, and distention would not be likely to lollow operation. In operations, damp, cold rooms and corridors were to be avoided. It was important to use warm, dry blankets. An operating-taTale made of mani- fold coils of steam pipe was a simple and perfect way of treating shock. Unnecessary prolonged anasthesia should be avoided. It mattered not how chloroform killed, it did so oftener than ether, and should not be used. He protested against rude, rough handling of patients as a Kentuckian would a package of fine old bourbon. ec-naprosyn price The operator should have an accurate knowl- edge of his materials. He condemned catgut, and used fine silk. Officers Elected. — At this juncture. Dr. Joseph East- man, of Indianapolis, was elected Chairman, and Dr. McKelway, of Philadelphia, Secretary of the Section for the ensuing year. The papers by Drs. Martin and Price ware discussed to- gether, the remarks being directed chiefly to the methods of operating for fibroid tumors. Most of the gentlemen emphasized the stand taken by Dr. Martin, that the pro- cedure should be varied according to the case. Much was said about intra-abdominal but • extra-peritoneal method of treating the stump, leaving the cervix and cov- ering it with flaps. It was participated in by Drs. East- man, Noble, McLaren, Reed of Cincinnati, Boldt, H. A. Kelly, H. O. Marcy, McMurtry, Humiston, C. R. Reed, Carsten, E. P. Davis, and the authors. Dr. Reed, of Cincinnati, used chloroform, and said he had never seen but one patient die on the table in anaes- thesia, the mixed vapors being used. When chloroform killed, he knew it; when ether killed, it was by pneu- monia, nephritis, or uraemia. He had had four deaths in which ether was the cause some days after operation ; none from chloroform. Dr. B(1Ldt advocated catgut. Dr. Kelly would never use it again, having lost by sepsis carried by it four cases after a long series of success- naprosyn ec fort 500 mg ful cases of cceliotomy. He now used only fine silk. Dr. Carsten had come to use only kangaroo ligature. The discussion revealed a growing distaste for attach- ing some supposed inventor's name to a given method of operating. Dr. Marcv expressed his feeling on the sub- ject by allusion to the story of the father who said to his boy: " Horatio, Horatio, don't attach your name to a speculum and have it go dangling down the ages like a tin can fastened to a dog's tail, for I have been your father. ' ' Dr. Price said Leidy was once lecturing on the kidneys, and forgetting the name of certain little bodies, a student remarked, " Malpighian. " " Oh, yes, I wish old Malpighi was in hell 1 " It was results posterity would be interested in, not names. Dr. Price was the only one who advocated rather warmly supra-vaginal hysterectomy and fixation ot' the pedicle in the abdominal wound : the reason being that out of over forty cases he had lost none. He would do total where can i buy naprosyn extirpation in preference to leaving naprosyn 500 mg oblong yellow tablets the cervix as in what had been spoken of as Baer's method, although it had been described before Baer had done it. Third Day, Thltrsdav, June 8th. Ventral Hernia following Laparotomy — Its Cause and Means of Prevention. — Dr. H. (). Marcy, of Boston, presented a paper on this subject, and said: "Although we live in the era which is denominated revolutionary in the science and art of surgery, he who proposes modifica- tions to long-established rules should do so only after the most convincing evidence of their manifest advantage and importance." It was admitted that about ten per cent, of all laparotomies resulted in ventral hernia; and in order to prevent this, it was quite the standard rule to apply a lacing abdominal support to be worn for months. But it was ineffectual. The importance of including the peritoneum within the sutures was early shown by Sir Spencer Wells, who advised the approximation of the divided edges of the wound with the utmost care. During the past eight years he had employed ex- clusively the buried tendon suture in closure of abdominal wounds, e.xcept for a few months when he could not get it. For more than ten years previous to this naprosyn gel costo he had used the buried animal suture in a great variety of wounds, and was led to its adoption in laparotomy because of its exceptional value in reinforcing the weakened structures, especially as demonstrated in operations for the cure of hernia. His method from the first had been essentially the same. The peritoneum naprosyn ec 500 mg pl was closed separately. This might be effected in ec naprosyn rxlist a variety of ways. For ease and rapidity, if for no other reason, the continuous suture was to be pre- ferred. He usually employed the double continuous ten- don suture (kangaroo tendon), which was easily and rap- idly taken by the use of a needle with the eye near the point, and which, by rethreading with the opposite end, permitted the introduction of the suture from either side through the same puncture. The result was an even, con- tinuous, and close apposition of the serous surfaces of the peritoneum, retained at rest without undue constriction. A fine tendon was used. When one of the recti had been incised, it was better to rejoin the muscles by a row of sutures. This finished, he considered the accurate co- aptation of the thick investing fascia (linea alba) of the first importance. This was preferably effected by a line of sutures taken in a similar manner to the one closing the peritoneum. The more or less thick layer of fatty tissue was preferably brought into apposition by one or two light lines of running sutures. Care was taken that the needle reenter exactly opposite the point of previous entrance, at right angle to the line of incision, so as to secure perfect coaptation. It was called by him the par- allel suture. The suture was buried. A layer of collo- dion, reenforced with a few fibres of cotton, applied to the well dried skin, completed the dressing. If the oper- ation had been conducted with aseptic care the wound must remain aseptic. In three hundred laparotomies, where a complete closure of its wound had been thus effected, he recalled but two cases of ventral hernia. Undoubtedly, one of the most common causes of hernia was the routine use of drainage-tubes, by which a portion of the wound naprosyn generic naproxen was necessarily kept open. He hid used drainage-tubes in scarcely more than three per cent. A second and common cause of ventral hernia was imper- fect coaptation of the wound edges by the interru])ted suture, even when used with can you get high off naprosyn 500mg the utmost care. The sut- ure itself, aseptic, aseptically buried, in aseptic wounds, marked one of the greatest advances in buy naprosyn tablets modern surgery. In over six hundred cases of wounds thus treated in his hospital the result showed less than two percent, of suppu- rative wounds, Dr, Schooler, of Des Moines, la,, found interposition of peritoneum or fat between the united parts a chief cause of hernia. Dr. Cordier, of Kansas City, passed one suture through all the naprosyn costochondritis tissues, and thought it could be done so as to secure as nearly as it was possible to do it coapta- tion of peritoneum to peritoneum, fascia to fascia, etc. The skin was retracted, and the needle passed in, sloping toward the mesial line. The Propriety of Operative Measures in Pelvic Peri- tonitis, — Dr. Lkwis Schodler, of 1 )es Moines, la., read a paper with this title. On the one there generic naprosyn side were arrayed conservatives, with conservatism carried to timidity. On the other were the reckless and amateur operators, who occasionally might do good, but more frequently harm resulted. Cases of pelvic peritonitis differed in their buy naprosyn 500mg effects but little from general peritonitis save in degree and the lia- bility to form abscesses, Nocases were idiopathic. When moderate in degree, they recovered spontaneously or with the simplest treatment. much does naprosyn cost The effused lymph ec-naprosyn generic might 'oecome organized, and after subsidence of inflammation impor- tant organs might be hindered in function. Repeated at- July I, 1893] MEDICAL RECORD. 27 tacks increased the difficulties. In the latter all would agree as to importance of operating. But it was in the acute cases that the skill of the diagnostician and thera- peutist was put to the crucial test. A\'hen the tubes contained pus or the ovaries were diseased, he would re- move them. Intrauterine naprosyn sr tablet 1000 mg treatment in pyosalpinx had not been successful in his hands. The conclusions of the author were, that in acute cases operate as soon as it becomes evident other measures would fail. In chronic cases there were two periods when operation was justifiable : First, when life was en- dangered during a recurrence ; second, after subsidence of an acute e.xacerbation. The latter wa6 regarded as the preferable period, but it could not always be secured. The Essentials of Success in Vaginal Hysterectomy. — Dr. Henry T. Byford, of Chicago, read the paper.

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