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ease was not annihilated by one injection, the man was imbued with a false idea as to his true condi- tion. Dr. match 21 card game Frederic S. Mason, of New York, stated that while salvarsan might not be as good as mer- cury, when it was used the acute symptoms were relieved quickly. He mentioned the case of a wom- an who had the acute lesions of syphilis and was attending to her business; she received injections of salvarsan, and within a week match play 21 blackjack game practically all the lesions disappeared. This was the principal ad- vantage in using this agent. Dr. S. Grovi:r Burxett, of Kansas City, Mis- souri, reported a case of acute delirium following the chloroform habit. Difficulties Encountered in Late Operations for Intestinal Obstruction. — Dr. Herman E. Pearse, Kansas City, Missouri, said that by observ- ing the following procedures the late cases of in- testinal obstruction could be saved: i. By empty- ing the bowel at first operation and allowing time to recover from to.x;emia before resection was practised, unless gangrene should forbid. 2. This should be done by employing the long intestinal tube and emptying the distended bowel as the first step after finding the obstruction, closing royal match 21 blackjack machine the wound after providing escape. 3. By the use of a glass tube of Paul or the rubber tubes with depressed external grooves, as advised by Andren I\Iarro, to convey the toxic f3ecal matter beyond the wound, thus securing primary 'union and safety from ab- scess. 4. By bringing the bowel edges out of the incision beyond the skin and substituting the open treatment by a nurse and water washing for the closed method of filthy gauze and play royal match 21 online pads of cotton. 5. By employing a second and even third operation to complete the work when the patient had recov- ered from the effects of the obstruction and vomit- ing. Dr. John E. Summers, of Omaha, stated that sometimes in cases of strangulated hernia, where gangrene was present, one could establish an arti- ficial anus by cutting into the gut, allowing it to remain there fastened until the circulation was re- established, and then an operation could be done later. If drainage was carried out, it was wise to wash out the gut through a tube. Dr. C. Lester Hall, of Kansas City, Missouri, differed with the essayist in regard to the incision. He said we could open the abdomen more widely and freely and reach parts of the abdominal cavity better through a median incision, and there was less trouble through that incision in the after treat- ment, and union was better there than in any other part of the abdominal wall. Dr. O. Beverly Campkell, of St. Joseph, agreed with the essayist that a good place to make the in- cision was about the border of the right rectus, be- cause there was more trouble in the right side in intestinal obstruction than anywhere else, and the fact that one wanted to drain in the median line. Therefore, he would favor the incision at this place in most cases. Dr. S. H. Smitii, of Omaha, reported a case of intestinal obstruction in a woman. The obstruction was caused by three constricting bands around the sigmoid flexure. These bands were cut. There were adhesions around the cascum which were broken up. Three days after the operation the pa- tient had natural bowel movements without the use of purgatives. Dr. "F. H. Clark, of El Reno, remarked th-;t shock in abdominal operations came more from the rough handling of the intestines than from any other single thing that entered into surgical work in the class of cases under discussion. A prominent surgeon told him not long since that he attributed his remarkable success to two things : First, he had acquired a technique which enabled him to get in and out of the abdomen in a much shorter time. and, second, he had learned to handle the intestines just as gently as it was possible to do so. Dr. John P. Lord, of Omaha, stated that when there was a gangrenous gut to deal with, he be- lieved it should be excised ; then we would have an open bowel and could drain. We should not pack it with gauze and cover it with rubber tissue. The r\Iurphy button tempted one to make an immediate anastomosis, which would be the means of causing the patient to suff'er from a toxaemia that killed so many patients that had so called secondary shock. He did not believe in secondary shock unless it was a secondary haemorrhage. Dr. S. G. ZixK, of Leavenworth, Kansas, report- ed three cases of fa;cal impaction, and said he had found that by using a twenty-five per cent, solution of hydrogen peroxide, and putting the patient in the knee chest position, or exaggerated Sims po- sition, with the head low down, one or two injec- tions of eight ounces, followed by irrigation, would break up these fjecal masses. Dr. C. H. Wallace, of St. Joseph, said that for the average surgeon, who met these cases only oc- PROCEEDINGS OF SOCIETIES. "53 casionally. he was satisfied that the simpler method of dramage by play spanish 21 match dealer online free the introduction of a large tube would result in a greater saving of life than more extensive work. Dr. J.\C0B Geigf.r, of St. Joseph, remarked that early and correct diagnosis was most important. It was' easy to say what to do, but every case was a law unto itself^ and when the surgeon had a case of acute intestinal obstruction and opened the ab- domen and saw the patholog}', then he had to use his match play 21 brains to determine what was best to do. Dr. \'. L. Tkeyxor. of Council Blutifs, Iowa, be- lieved that if efforts how to play royal match 21 were directed toward a more certain and early diagnosis, it would simplify the treatment of these cases very materially. He did not like to hear the internists criticised for so called neglect when the surgeon himself was sometimes incapable of making a diagnosis when he was called early. Dr. C. C. CoxovER, of Kansas City, Missouri, stated that modern methods of diagnosis had been improved so wonderfully in the past four or five years that most internists could make a diagnosis of intestinal obstruction, and they did not need to wait and call in a surgeon to tell them what was the match play 21 odds matter with the patient. Dr. H. M. match play 21 blackjack game Cl.\kk, Platte City, Nebraska, ob- served that when country practitioners called in surgeons and thej- operated in cases of intestinal obstruction and lost forty or fifty per cent, of them. he thought the practitioner could do nearly as well himself. The Rbntgen Ray in Postoperative Cases. — Dr. R. D. Maso.v. of Omaha, showed the value of the X ray in cases where operation had been done and advised its use in all postoperative work where malignancy was suspected. He pointed out the fal- lacy of waiting until a return of the tlisease ap- peared before beginning the use of the rays was considered.

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