Vol. 60, 1909 - University of North Carolina at Chapel Hill

hS THE CHARLOTTE MEDICAL JOURNAL.
difficulty in collecting a reasonable fee for epsum salts increases materially the draintheseconsultationsinmost
cases, and where age of the lymphatics by osmosis. If the
they are unable to pay, my colleagues have granulations adhere to the mesh of the
responded as cheerfully as in the first in- gauze, a piece of perforated gutta percha
stance, and I find a constantly increasing tissue may be placed over the wound before
demand by the patient for this collective the gauze and adhesive plaster are applied,
examination. The indications for such a dressing are
Brother physicians, let us make it a per- chiefly if not entirely in those cases where
sonal equation. Vou are sick. Operation it is essential to reverse the current of lymph
advised. Would you rather go to one skilled in the local tissues and obtain drainage insurgeon
and leave it all to him, or would stead of absorption of both the toxines and
3'ou rather have four or five different spec- bacteria. The usual method of treating ;
i
',
ialists go over you, and then refer you to infected wounds at the present time is by ,ti
surgeon? means of a moist antiseptic dressing. In i
Operations in grave diseases at best are the more virulent infections corrosive suboften
worse than useless. My experience limate solution of various strengths is used.
with surgeons is that they show cold feet Corrosive sublimate, as its name implies, is
sooner than the ignorant laity. Why is a caustic, and even if used in dilute soluj
'.
j
.
j
this? The Golden Rule eminently fits the
surgeon.
tion acts as an astringent by coagulating
the albumen and thus tends, in spite of the
f,
Co)iciii>:ions capillary drainage, (if the dressing is kept ;
Ist.-The surgeon and the gvn«.cologist
^° ^^^^ the wound and interfere with .
;
'
'^'''f
^^f drainage of the local lymphatics In |
are a part of general medicine.
2nd.-General medicine is too broad for °^^^' "O';'^^'
'| '« ^^^.^ important to dram .
one man, hence the necessity of specialists, the local ymphatics of their bacteria and .
|
ord.-The specialist, unguarded and un- toxines than ,t is to simply destroy those ^
advised, is inefficient and often dangerous. Present m the superficial layers of the ,|
4th.-Surgery is brain-dexterity and con- ^^^""'^ ^^>' ^^^"^ of an antiseptic which !
coagulates albumen.
science
3th.-The highest type of surgerv is con- ^" 'he treatment of cancer we are con- j
"
.^^antly
sultative and
reminded of the evil effects of local j
institutional.
'"'tation
6th.—The
causing
consultative must
an increased blood sup-
be efBcient
and cover the whole field.
P'y t° the part which ni turn increases ma-
7th.-Inadvised and promiscuous surgery Penally the virulence of the mahgnant cells !
\
present. This is too often well illustrated
should be discouraged.
8th.-Surgical conscience must be culti- ^M the results obtained following the use j
.^^j-gjj
of caustics or partial removal by the knife.
9th'.-The surgeon and gynaecologist are „'^|^^ ?,^'''1*"^1 principles of the Open |
not entities, but integral parts of a whole.
lOtli.— It is time for me to close.
Method freatment of Cancer, which I first
described in a paper read before this Society
in Charlotte in 1906, are: 1st. Enuclea-
An Antiseptic Leech.
tion. 2nd. Drainage. 3rd. X-Ray. Even
By \V. D. Witherbee, M. D., Professor of Sk
Diseases and Materia Medica in the North Care
if the enucleation is carried out according
to the dictum "cut 011I3' in normal tissues"
,. ,. ,. , „ „ ^. , ^. ,, ^ that is wide of the diseased area there can
hna Medical College, Charlotte, N. C. , , , , »i . .1 c .1
be no doubt that even then some of the
Another name for this dressing, quite as malignant cells still remain. The inflamappropriate
as the title, would be a lymph- matory reaction or congestion of blood
atic leech. In fact this might better imply which always takes place about every
the function for which it is designed. wound causes the embryonic cell or cells
The antiseptic leech consists of a piece of which still remain in these tissues to take
sterile gauze dipped in a solution of mag- on more life and virulence and eventually
nesium sulphate. The surface to be directly produce a recurrence which is invariably
applied to the- wound is sprinkled with a more malignant than the original condition,
little powdered boracic acid. The gauze is The method used to overcome this inflamthen
applied to the granulating surface and matory reaction, as well as to promote more
over this a piece of adhesive plaster is thorough drainage about a wound foUowplaced
in such a manner as to completely ing operation in a case of epitheleoma of
cover the moist gauze and at the same time the skin, is by the application of the antiseal
it from the air to prevent evaporation, septic leach as well as the daily application
The reason for preventing evaporation is of the X-Ray. If the case is one of mucothat
capillary or lampvvick drainage is cutaneous surface it is impossible to apply
maintained just so long as the gauze re- this dressing. After the removal of the dismains
moist. Besides capillary drainage eased area a cut is made in the mucous
,