Cod liver oil has never been considered a sea sonable remedy in summer. In Scott's Emulsion, Its use is productive of only the best results, summer winter. or SCOTT & BOWNE, Chemists, 409 Pearl St., New York City TRI-IODIDES (HENRY'S) Colchicin 1-20 grain. 7 .$1.00 Liquor Sali-lodides. A powerful alterative and resolvent, glandular and hepatic stimulant, and succedaneum of the iodides. Indicated in all conditions dependent upon perverted tissue metabolism; in lymphatic engorgements and functional visceral disturbances, in lingering rheumatic pains which are "worse at night" Bone, periosteal and visceral symptoms of late syphilis; for the removal of all inflammatory, plastic and gouty deposits. A remedy in sciatica, megrim, neuralgias, lumbago and muscular pains; the gouty and rheumatic diathesis; acute and chronic rheumatism and gout; chronic eczema and psoriasis, and all dermic disorders in which there is underlying blood taint. hepatic stimulant increasing the quantity and fluidity of the bile. An and intestinal torpor; does not cause the unpleasant gastric symptoms of potassium Relieves hepatic iodide. THREE CHLORIDES (HENRY'S) Each drachm contains $1.00 Liquor Ferrisenic. An oxygen-carrying ferruginous preparation, suitable for prolonged treatment of children, adults and the aged. Indicated in anemia and bodily weakness, convalescence from acute diseases and surgical operations; boys and girls at the age of puberty, and the climacteric period in women. In children with chorea, rickets, or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration never causes "iron headache.' As an adjuvant for potassium iodide the undesirable manifestations known as iodism can be removed. Stimulant to the peptic and hydrochloric glandular system of the stomach, especially serviceable in the impaired appetite, nausea, vomiting and other gastric symptoms of alcoholic subjects. MAIZO-LITHIUM Nascent Chemic Union .... $1.00 Liquor Lithium Maizenate. A genito-urinary sedative, and active diuretic; solvent and flush indicated for the relief and prevention of renal colic; a sedative in the acute stage of gonorrhea, cystitis and epididymitis; in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied manifestations of gout, goutiness aand neurotic lithemia, periodical migrainous headache, epigastric oppression, cardiac palpitation, irregular, weak or intemittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in action and definite in results than mineral waters. Those cases of irritable heart, irregular or with by insurance examiners and found to be due to excess of uric acid, are special intermittent pulse so frequently met indications for Maizo-Lithium. HENRY PHARMACAL CO., LOUISVILLE, KY. PAPERS READ AT THE SEMI-ANNUAL MEETING HELD IN KANSAS CITY, MARCH 23 AND 24, 1905. T DRAINAGE IN ACUTE, DIFFUSE SEPTIC PERITONITIS. Van Buren Knott, M. D., Sioux City, Ia. HE term diffuse septic peritonitis as employed in this article refers to an acute septic inflammation of the peritoneum so widespread in extent as apparently to involve its entire surface, and which is accompanied by marked changes in the appearance of the membrane The division of and in the quantity and quality of its fluid contents. widespread acute peritoneal infections into two or more forms seems both cumbersome and unnecessary as all the cases seen by me have presented the same general characteristics varying only in degrees. This variety of peritonitis is usually due to perforation of some of the hollow viscera with extravasation of septic material into the general peri toneal cavity. The rapidity of the process depends upon the nature of the infecting medium and upon the point at which it is released. Perforation of the stomach or duodenum is followed more rapidly by symptoms of a spreading peritonitis than a perforation of equal size taking place in the pelvic portion of the digestive tube, because gravity quickly carries the infection across the entire peritoneal cavity from top to bottom while from the low perforations this widespread soiling must be brought about by the slow but no less certain agents, peristalsis and absorption. In the class of cases under consideration the peritoneum is found everywhere deeply congested. Some portions have begun to lose their lustre, while others are already roughened and lustreless. Patches of fibrin are scattered promiscuously over the surface, and here and there may be found slight adhesions between the intestinal coils. The fluid contents of the peritoneum are usually much increased in quantity, but in some cases seen early this increase will be found to be less than the gravity of the symptoms would indicate. Serum no longer, the fluid will be found of varying consistency and color. At times it appears as pure pus, at others thin and of a greenish tinge. Again, and especially when less than the usual amount of fluid is found it will be brown in color. In some cases the entire cavity seems fairly well fitted. In other the fluid will be found occupying the various fossae or the cul-de-sac. Previous to the year 1900 the surgical treatment of diffuse septic peritonitis was attended by results which tended neither to establish it, as the method of choice. nor to furnish an agreeable retrospect for those of us who now "know better." With a mortality rate approaching 100 per cent these cases were viewed with dismay by the surgeon. Better knowledge of the etiology and pathology of the condition demanded that the patient be given the chance for life which surgery alone could offer, but the knowledge necessary to the application of this means of relief was acquired more slowly and at tremendous cost. Actuated by a sense of stern duty, regardless of consequences, to himself or his professional reputation, the surgeon operated upon such cases as were not actually moribund, employing the methods which at the particular time were accepted as correct, and was then compelled in most instances to watch the steady and relentless progress of the disease to a fatal termination. During this period of discouraging experiences we gladly welcomed and eagerly adopted any suggestion as to the managment of these cases which seemed rational, and which had in the experience of a trained operator proven even of slight benefit. Within a comparatively brief period the following procedures were advanced, and more or less generally applied by the surgical world in the effort to conquer the dread disease. The cleansing of the peritoneum by evisceration and dry sponging. By dry sponging without visceration. By copious irrigation of the entire sac at the time of operation. By continuous irrigation maintained for hours or days after operation. By more or less limited irrigation applied to the region from which the infection originated. By simply affording an outlet for the escape of pent up septic fluid making no further effort to hasten its removal. The attempt to drain the peritoneal cavity into the intestine by introducing through a trocar, large quantities of saline purgatives into the small intestine at the time of the operation. Capillary drainage by multiple or single strands of iodoform gauze, then plain guaze, then wicking, then the cigarette drains large or small, one or many. Glass drainage tubes large and small straight or crooked inserted here. and inserted there. Rubber drainage tubes of all sorts and sizes used with or without gauze. The wound was left wide open filled with gauze drains, was partly closed about the drains, or was closed tightly with no drainage. Counter openings for drainage were made in the loin and flank. Careful dissection of the male perineum to permit the passage of a tube into the lower pelvis was recommended. Vaginal drainage by tube or gauze, or both also belongs to the list. Then we find ourselves attempting to drain this septic area into the already choking lymphatics of the sufferer by raising the foot of the bed and flooding the diaphragmatic or absorbent area of the peritoneum with the contained septic fluids. The variety of methods above mentioned, as well as the many opposing principles represented by them graphically portray the unsettled and dissatisfied state of the surgical mind regarding the treatment of this disorder. In 1900 Dr. Geo. Ryerson Fowler, of Brooklyn, published an article describing postural post-operative treatment of diffuse septic peritonitis. The article above mentioned marked a new era in the history of this disease supported as it was by the records of nine consecutive cases which recovered. Never before had any one been able to report such a series of successes in its treatment, and in fact it is questionable whether so many recoveries had up to this time occurred in the practice of any one man. To most of us the description of the elevated head and trunk posture came with telling force We had so long and patiently tried the various exploited methods of combating diffuse septic peritonitis, with such distressingly unsatisfactory results that the vista thus suddenly opened before us seemed too good to be true. As has been shown by Fowler, Clark and others absorption takes place most rapidly from the diaphragmatic peritoneum, particularly around the central tendon of the diaphragm and the absorbent qualities of the membrane steadily diminish from this point downwards until the lower pelvis we find that a localized septic process may exist for many days without exciting much constitutional disturbance. In view of the fact that the position advocated by Fowler accom plishes what common sense should dictate in the light of our knowledge of the physiology of the peritoneum we wonder that its employment was not sooner urged. In our work involving the treatment of septic processes we strive unceasingly to accomplish as completely as possible their localization to the part first attacked, and to provide for the products of infection the freest external drainage. The treatment of peritoneal infections offers no exception to the above general rule, and in my judgment the greatest advance yet made in the furtherance of this treatment is the elevation of the head and trunk, thereby draining the high and extremely . |