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liness, and yet his results are uniformly good. He gave an exhibition of this " dirty surgery" upon the body of a dog, fearlessly cutting open the abdomen, inserting his unwashed hand into the peritoneal cavity, making a rough gut- resection, the ends loosely joined with three or four stitches, and the large abdominal wound closed with only a single stitch. He showed several s])ecimens of former operations in which the gut had healed per- fectly and no stenosis had resulted. He has found that the peritoneum can invariably care for any dirt or even ■ small particles of faeces with impunity to itself, though the outer wound does not do as well as when asepsis is secured. He believed that what is true of the peritoneum of the dog is also true of that of man. His object in pre- senting these cases to the Society was noi in any way to lessen the importance of asepsis and antisepsis in abdomi- nal surgery, for he is a firm believer in them, but to en- courage general practitioners to operate immediately in cases of emergency, such as perforating wounds of the in- testine, even if their technique is not perfect, rather than to make the fatal mistake of delaying until a specialist can be summoned from many miles away. The paper created a lively discussion, and inasmuch July 8, 1893] MEDICAL RECORD. 57 as the canine peritoneum cannot be properly compared with the human peritoneum, the danger of such teaching, in tending to reduce Order Serevent carefulness in abdominal surgery, was clearly pointed out. Second Day, Wednesday, June 7TH. Stricture of the Ureter. — Dr. Christi.\x Fencer, of Chicago, described an operation for the relief Purchase Serevent of stricture of the ureter in cases of hydro- or pyo-nephrosis. Lum- bar nephrectomy has a mortality of thirty-seven per cent. . while nephrotomy, including twenty-two per cent, for the primary operation and seven per cent, for the second- ary closing of the fistula, has only twenty-nine per cent. Still, nephrectomy is a single operation and cures imme- diately, if at all. But there are certain cases of hydro- or pyo-nephrosis where it is not indicated. In many cases intermittent Purchase Salmeterol hydronephrosis is due to the oblique opening of the ureter into the pelvis of the kidney, which causes its closure until the pelvis is moder- ately distended, when there is a discharge of its contents. In these cises an incision can be made into the pelvis of the kidney through the usual lumbar incision, and Purchase Serevent Online the opening into the ureter can be made more patulous by simple plastic surgery. The author reported a successful case of such procedure. .\gain, hydroneiihroiis from stricture of the ureter, due either to ureteritis or partial rupture from traumatism, can be successfully treated without a nephrectomy. If the Order Salmeterol stricture is a limited one, a short longitudinal incision can be made through the stricture, followed by the union of the opposite ends of the incision, so that the line of sutures is transverse although the incision was longitud- inal. He reported a successful case of this operation. The upper two-thirds of the ureter can be reached through the lumbar nephrotomy incision extended downward if necessary ; the lower third by making an osteoplastic flap of the sacrum. Transverse union of a section of the Generic Salmeterol ureter is rarely successful, and lateral anastomosis and other methods re- quire an e.xceptional length of the ureter. When possible, nephrectomy should be avoided, as fre- quently the hydro-nephrotic kidney retains remarkable secretive power and the soundness of the other kidney cannot be definitely ascertained. Therefore the opera- tions indicated by the author are a step toward conserva- tism. Operations on the Gall-tracts. — Dr. J. B. Murphy, of fhicago, read a paper on this subject. He called atten- tion to the anatomical relations of the gall-bladder, rec- ommending an incision over the ninth right costal carti- lage in all operations upon that viscus. The single function of the gall-bladder is to control the tension of the gall circulation, and it is not necessary to life. In dogs after its removal he has Buy Salmeterol observed the gradual disten- tion of the cystic duct until it replaces the removed gall- bladder. Healthy bile is not septic ; but bile which es- capes pathologically into the peritoneal Buy Serevent cavity is septic, owing to the pathological cause. The author has collected 25 cases of simple surgical puncture of the gall-bladder for diagnosis, \\-ith a mortal- ity of twenty-five percent. Of 23 cases of simple inci- sion and drainage, eighteen per cent. died. In 59 cases of primary suture of the Order Serevent Online gall-bladder to the abdominal wall and a secondary incision, the mortality was ten per cent., the lowest of all operations upon this viscus. In 201 cases of the same operation but done in one sitting, twenty-five per cent. died. In cases where all the bile drains outside the patients Purchase Salmeterol Online die of marasmus, and those operations which retain the flow of bile in its natural channel are far preferable. In cholecystotomy without drainage the Generic Serevent mortality is twenty-three per cent. The author strongly advises cholecystoenterotomy. joining the gall-bladder to the intestine near the normal opening of the common duct. He has done this, using a button similar to his intestinal button many times in dogs, with universal success. He has operated in this manner seven times for encysted gallstones in man, and his colleagues two more times, and all nine cases are liv- ing. In one operation for pancreatic cancer death re- sulted from causes not attributable to this method. The author points out the dangers of protracted ab- dominal operations and the saving of valuable time by the use of his intestinal button. He operated upon a living dog before the Section, com- pleting the operation in about ten minutes. Intestinal Anastomosis Without Plates. — Dr. M. E. CoNNELL, of Wauwatosa, Wis., described his improved method of securing intestinal anastomosis. Diagrams and specimens were shown to the meeting illustrative of the author's new method. This is a' lateral anastomosis by means of longitudinal incisions into the sides of the intestine after the closure of the open ends. The method is new simply in the suturing employed, and consists ot an uninterrupted Buy Cheap Salmeterol through and through suture of the two adjoining sides of the incisions, but with the loops of each stitch left long enough to allow the intestines to be turned until the two further sides of the incisions can be appro.ximated and then sewed by a tight continuous sut- ure. The intestines are tL t turned back again, and the first suture is drawn tight until the loops have disappeared and the knots are secured. This method has proved very successful in operations upon dogs, and as it requires but a few minutes for its completion, its advantages over more complicated methods of suture are obvious. A Case of Chronic Glanders, with Recovery was re- ported bv Dr. B.\v.\rd Holmes, of Chicago. Glanders is rare in man, and presents itself in one of two forms, either an acute affection fatal in the course of a few weeks, or else a distinctly chronic disease. The author pre- sented a patient, a farm hand, twenty-six years of age, who, four years ago, after caring for a horse suffering from glanders, was attacked by multiple abscesses. These were very radically treated by operation and their con- tents were used for inoculation experiments upon rab- bits and guinea-pigs, with the result of death in the rabbits and orchitis in the guinea-pigs. For two and one-half years the patient was subjected to operation twenty times, either for the elimination of new foci or the recleaning of the old ones. The wounds all healed slowly. The pa- tient is now entirely well. A New Operation for Varicose Veins was described by Dr. Ernest L.-\Pi.ace, of Philadelphia. As the vari- cose veins are aneurismal in character the treatment can Buy Cheap Serevent rightly be compared to that of aneurism. Radical measures are usually limited to acupressure, ligature, or excision. The measures employed to cause coagulation are too painful and too limited in the extent of their action. The long saphena drains the front of the leg and the circumference of the thigh, and the short saphena drains the posterior surface of the leg. The author's method is to ligate both veins, the long saphena at the saphenous opening and the short one just below the popliteal space. Elevation of the limb and rest in bed for a fortnight is the after-treatment. The author has done the operation seventeen times with perfect success, with the exception of one case in which there was an anomalous position of the long saphenous. The advantages of the operation are that it can con- trol very extensive varicose veins, that it can be done eas- ily with cocaine, and that no relapses have occurred. Dr. R. M. Ricketts, of Cincinnati, presented some specimens and a diagram illustrating the method of the Mansell operation of intestinal anastomosis. Partial Amputations of the Foot. — Dr. T. H. Man- ly, of Xew York, read a iiaper on this subject. In spite of the fact that instrument-makers say that partial amputations of the foot yield results less satisfac- tory than amputation of the leg at the point of election with the application of an artificial leg, the author wished to uphold the old principle of the preservation of healthy structures as far as possible. The more he sees of lacera- tions of the feet the more doubtful tissue he spares. Al- 58 MEDICAL RECORD. [July 8, 189: though the result of the tarsal amputations is not always satisfactory, an amputation of the leg later can always be resorted to if necessary. Nor is the artificial limb so in- variably satisfactory as it is often represented. It neces- sitates time, care, and expense, and not infrequently causes trouble in the stump. Appendicitis. — Dr. Jos. Hoffman, of Philadelphia, presented a communication on inflammation of the ap- . pendix. The author reviewed the various anatomical positions of the appendix, which account for the variety of the places to which the pain is referred and the diffi- culty of finding the appendix in some operations. To arrive at a diagnosis in doubtful cases the moderate use of salines and calomeNs of great value. The aspirating nee- dle should never be used, an exploratory incision being much safer. Operation should not be delayed in those cases which do not do well, and should be immediately employed when any evidence of suppuration Buy Serevent Online is present. Regarding the operation between attacks, the author ad- vises operation after even the first well -authenticated attack of appendicitis, to prevent any chance of a recurrence. Extirpation of Aneurisms. — Dr. Joseph Ransohoff, of Cincinnati, read a paper with this title. The operat- ive methods of treating aneurisms are the Hunterian proximal ligation, the splitting of the aneurismal sac with ligation above and below, and lastly the total extir- pation of the aneurism. The disadvantages of the first method are its high rate of mortality, about eighteen per cent., the frequent recur- rence of the aneurism even after the lapse of years, and the frequency of gangrene and Buy Salmeterol Online secondary hemorrhages. In the second method the sac is left behind and is practically a foreign body, often giving rise to suppura- Order Salmeterol Online

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