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has been complete. And be careful never to push the bowel into an interstice between the muscle or into superitoneal tissue.
Never try fluctuation across a limb, always along it.
1. Abscesses near a large joint often communicate with the joint.
2. Abscesses near a large artery sometimes communicate with the artery.
3. Abdominal wall abscesses sometimes communicate with
Never forget that early openings are imperative in abscesses situated :
1. In the neighborhood of joints.
Remember the frequency with which hematoma and traumatic aneurism have been mistaken for abscess, and incised; and remember, also, that in extravasation below the gluteal fascia there is rarely any sign of bruise or injury to the skin. Never incise such without ausculation or exploratory puncture.
Never plunge; never squeeze in opening abscesses. Do not forget that your incision should radiate:
1. In abscesses pointing near the nipple. 2. In abscesses near the anus.
3. In scarifying the chemosis of the cornea. And that your
incision should be longitudinal: 1. In the hand. 2. In the urethra. 3. In the scalp.
Do not forget that incisions in the neck and face should run parallel with the wrinkles and folds.
Do not be afraid of hurting the lacteal tubes in mammary abscess. More harm is done to the gland by the enlargement of the walls of the abscess than by a free incision.
Never make a palmar incision, except in the middle of the lower third and in the axial line of the fingers, or at the sides of the palm.
Do not open an abscess anywhere near a large artery without first using a stethoscope, and then only by Hilton's method (i. e., director and dressing forceps).
Never, under any circumstances, use for exploratory puncture that surgical abomination, a grooved needle, for it will allow contamination of all the tissues through which it brings the fluids. (Thornton.)
In opening a deep abscess in the lumbar region without the projection of an abcess, do not forget to cut down opposite a transverse process, and not between them, for fear of wounding a lumbar artery.
Aneurism. Never attempt to cure an aneurism by the formation of a thrombus if the patient has any septic condition (such as an abscess, sore, suppurating otitis), for such may induce yellow softening of the clot.
Artery-bleeding. Always tie both ends of a divided artery in a wound.
Bladder and Urethra. Never neglect to pass your hand over the patient's belly in typhoid, or any fever, injury, or fracture of the spine, compression, etc., for the bladder may be atonic and injuriously distended without distress.
Never use force in passing a catheter in fractured spine, because of the insensitiveness of the urethra.
Do not forget that irritability of the bladder is often due to renal irritation and reflex actions.
Never inject more than four ounces at a time into the bladder, and that only with care.— Times and Register.
This rather complicated condition is one which requires great care in its therapeusis, and its treatment is frequently of a prolonged character. Many methods have been proposed with more or less success attendant upon their application. One of the best which has been devised is that of Dr. Martineau, of Paris, who has definitely cured 67 out of 70 cases in the past twelve years. Dr. Dujardin-Beaumetz has also recommended
and even adopted this treatment, in which they have employed carbonate of lithium and arsenic in such manner as it is combined and manufactured by Enno Sander, whose formula is as follows: R Lithium bicarbonate, gr. 5.514; sodium arseniate, gr. 0.100; carbonic water, 3 16.00. M. This quantity, which is the contents of one bottle, should be taken, mixed with claret wine, at three successive meals. The diet need not be restricted, with the exception of starch, sugar and fruit. The latter articles should be prohibited, but in so far as the rest of the diet for diabetics is concerned, considerable freedom may be permitted. In taking the water, care must be exercised to drink it either during or immediately after eating, although it is a better and preferable method to take it during the course of the meal. The addition of the carbonic water renders the remedial agents less irritating to the stomach and also adds to its palatable qualities.—New Eng. Med. Monthly.
Induction of Premature Labor by Glycerin Injections.
Pelzer (Centralbl. f. Gynak.) gave a very satisfactory account of his experience of this method. He employs chemically pure, sterilized glycerin. A hundred cubic centimetres are thrown up between the membranes and the uterine wall. Full precautions are taken, not only against sepsis, but also against the entrance of air into the uterine cavity. In a short time regular pains set in. The membranes present well, and labor is usually easy. In two cases where labor was induced on account of contracted pelvis, the pains set in, in the first case, within half an hour, in the second after an hour. In a third case the patient was at the end of the thirty-second week of pregnancy. For fourteen days she had been flooding; there was placenta previa lateralis and a temperature of 104°. Glycerin was injected and pains set in in an hour and a half. Bleeding occurred two and a half hours later. Turning was performed and a dead child was delivered. The mother recovered. Glycerin injections are,
in Pelzer's experience, valuable not only for the induction of premature labor, but also for accelerating delivery at term. In uterine atong it proves very efficacious.
Gout and Rheumatism.
There can be no possible doubt that, despite the different opinions in regard to the cause of gout and rheumatism, alkalies exercise a very good action, and tend to relieve the system of that hyperacidity which seems to be always present. In this administration of alkalies, some care is to be exercised in order to avoid those disturbances of the digestive system which
may come on as a result of their continued administration. Among the best of the alkalies is lithium and its salts. Some, however, contend that its combination with other alkalies makes its action more sure and effective. A combination devised by an eminent practitioner is as follows: R Lithium benzoate, gr. 12.823; lithium bicarbonate, gr. 13.784; potassium bicarbonate, gr. 10.000; sodium chloride, gr. 10.000; carbonated water, 3 xvj. M. This makes a palatable effervescing mixture which is very grateful to take, as well as effective in action. Of course, it is impossible to prepare this extemporaneously. Dr. Enno Sander has made the above in his usual thorough manner, and has named it benzoated lithium water. Being palatable, it is taken by patients with a certain relish, and the peculiar taste of the alkalies does not manifest itself, being completely covered by the carbonated water. Weekly Medical Review.
Starting with Frankel's view, that the antiseptic properties of creolin depend upon some higher homologues of phenol, it was believed that the cresols in soluble form would be more active as disinfectants than in emulsion. The result of this study was the production of lysol, which contains fifty per cent. of cresols, is miscible with water, and forms clear solutions with alcohol, petroleum or benzine, chloroform, carbon bisulphide, and glycerin. Gerlach and others have found it active and prompt in arresting the development of microorganisms. Furbringer believes that after cleansing the nails with a one-half to one per cent. solution, the hands being immersed two or three minutes, using a brush, other disinfection is unnecessary. This process does not attack the hands. For sterilization of instruments, one-fourth of one per cent.
solution is sufficient. Cramer and Wehmer believe that it is five times stronger than carbolic acid, and one-eighth as poisonous; considering the weak solutions necessary, it is relatively cheap.-Med. Press.—Boston M. & S. Jour.
Catgut in Gynecological Operations.
Among the objections to the use of catgut are: the difficulty of sterilizing it, the liability of its knot to untie, and the rapidity with which it is absorbed.
Recent experience has convinced the author that the objections are in a great measure groundless, and that we have in catgut a most valuable surgical agent.
Having had several cases of ventral hernia following abdominal section, attention was drawn to the necessity of a buried fasciæ suture. For this purpose a continuous suture of catgut has been employed for two years with uniformly good results. In rents of the bowel and of the bladder, which are sometimes unavoidable in abdominal surgery, fine catgut sutures have been used with equal success. An advantage of catgut over silk in intestinal work is the fact that the gut swells and completely fills the needle holes, should the mucous surface be inadvertently punctured. In such operations as most of the plastic work in the vagina, the radical cure of hernia and of anal fistula, the removal of the coccyx, the extirpation of the vulvo-vaginal glands, or of labial cysts and tumors, and the amputation of the hypertrophied and prolapsed cervix uteri, catgut sutures are advocated. In any deep wound where several rows of buried sutures are needed, they are of especial service; but in plastic surgery, where but a single row of surface sutures are desired, they cannot be depended upon. The writer has not himself ventured to use catgut in operating for vesico-vaginal or recto-vaginal fistulæ or in doing trachelorrhaphy, although he has often been tempted to use it in the latter operation. A diversity of opinion exists among gynecologists as to the advisability of using it in operations upon the cervix uteri, and bad results are reported following its use. Many European surgeons insert successive tiers of catgut sutures in operations upon the peritoneum, and some employ it extensively in their abdominal