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

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ORIGINAL COMMl'NICATIONS. 149<br />

sentially an oper<strong>at</strong>ive surgeon. The skilful night's sleep, Trional grs. x is always<br />

diagnostic surgeon no longer oper<strong>at</strong>es for given. In the morning the p<strong>at</strong>ient receives<br />

every tumor, benign or not, as it comes, a simple enema <strong>of</strong> soapsuds and a second<br />

because the tendency <strong>of</strong> modern surgery is prepar<strong>at</strong>ion. We always begin to oper<strong>at</strong>e<br />

more conserv<strong>at</strong>ive than ever before. Radi- as early as possible in the morning, as by<br />

calisra is becoming a thing <strong>of</strong> the past and so doing the p<strong>at</strong>ient is saved the nerve rackis<br />

rapidly fading away before the gre<strong>at</strong>er ing waiting and <strong>of</strong>ten the tearful farewells<br />

and more exact knowledge <strong>of</strong> the surgeons <strong>of</strong> the family; the surgeon and the nurses<br />

<strong>of</strong> today. But I do say, th<strong>at</strong> because <strong>of</strong> are cleaner than l<strong>at</strong>er in the day. It is all<br />

lack <strong>of</strong> thorough study <strong>of</strong> the cases, jointly, important to have a skilled anpesthetist <strong>at</strong><br />

many cases <strong>of</strong> ovaritis, abdominal neuroses one's command who is to be trusted with<br />

and appendicitis, if you please, are oper- the administr<strong>at</strong>ion <strong>of</strong> nitrous oxide gas,<br />

<strong>at</strong>ed upon when they are not those diseases,<br />

but are reflexes from some other cause,<br />

ether, chlor<strong>of</strong>orm or ethyl chloride as we<br />

may elect; who will reassure the nervous<br />

Furthermore, when we get this exact cooper<strong>at</strong>ion,<br />

we will not make these mistakes,<br />

p<strong>at</strong>ient and gain their canfidence as well as<br />

<strong>at</strong>tend to the various pre-anaesthetic details,<br />

because we will then know, for instance,<br />

how much neurotic element there is, and<br />

how much real pelvic pain. In other words,<br />

such as seeing th<strong>at</strong> the table is properly pre-<br />

pared and th<strong>at</strong> the p<strong>at</strong>ient is sufficiently<br />

clothed and covered. It is our practice to<br />

we can sort out and deal with the evidence invariably give a hypodermic injection <strong>of</strong><br />

<strong>of</strong> pelvic pain, and the physician can help morphine sulph<strong>at</strong>e gr. 1-8— gr. 1-4 fifteen<br />

the surgeon in his desire to be conserv<strong>at</strong>ive minutes before the aneesthetic is commenced<br />

and constructive, and not radical and de- and it is better in p<strong>at</strong>ients who are nervous<br />

structive.<br />

In conclusion, I believe th<strong>at</strong> all <strong>of</strong> us,<br />

to anesthetize them in bed and carry them<br />

to the oper<strong>at</strong>ing table. My own preference<br />

[physicians and surgeons, wish and strive is for ether as the ansesthetic <strong>of</strong> choice<br />

iOnly for the best results for the p<strong>at</strong>ient, but though I have used scopolamine-morphine<br />

in our desire to be onesided, and all-power- anaesthesia in some fifty cases with excel-<br />

ful, as it were, we run <strong>of</strong>f too much into lent results and I believe th<strong>at</strong> its use is inspecialties,<br />

and wander away too far from dic<strong>at</strong>ed in certain cases. No time should<br />

each other. We should come back and get be wasted by the surgeon when the p<strong>at</strong>ient<br />

closer together, both for our own and for is brought in the oper<strong>at</strong>ing room and his<br />

the p<strong>at</strong>ient's benefit. Many a time the sur- procedures should be as rapid as is consistgeon<br />

may m.ike an an<strong>at</strong>omical cure, may ent with good, clean, thorough work, as<br />

remove a p ithological lesion, but even then shock is unquestionably increased by oper-<br />

it is just as necessary and just as essential <strong>at</strong>ions unduly prolonged, just as nausea is<br />

th<strong>at</strong> the referring physician should continue increased by large amounts <strong>of</strong> ether. It is<br />

to tre<strong>at</strong> the p<strong>at</strong>ient before a permanent cure not <strong>at</strong> all uncommon in some <strong>of</strong> the large<br />

can be effected, for many <strong>of</strong> these cases re- clinics connected with teaching institutions<br />

quire not only the tre<strong>at</strong>ment <strong>of</strong> the lesion, to see a p<strong>at</strong>ient fully anaesthetized and kept<br />

medically or surgically, but also the medi- waiting for ten or fifteen minutes whilst the<br />

cal and psjchic tre<strong>at</strong>ment <strong>of</strong> the p<strong>at</strong>ient, surgeon talks, or to see him stop in the<br />

and to get the best and most lasting results midst <strong>of</strong> his oper<strong>at</strong>ion to explain or dil<strong>at</strong>e<br />

we must have, even unto the end, hearty upon some condition which he wishes to<br />

:o-oper<strong>at</strong>ion, and an united interest, both make clear. Except in those cases recjuirn<br />

the primary diagnosis and succeeding ing drainage I use a very small, light dress-<br />

;re<strong>at</strong>ment, on the part <strong>of</strong> both physician ing, consisting <strong>of</strong> about four thicknesses <strong>of</strong><br />

ind surgeon. . gauze, secured by narrow strips <strong>of</strong> zinc-<br />

The Care ol Post Oper<strong>at</strong>ive Cases.<br />

oxide adhesive plaster. On the p<strong>at</strong>ients'<br />

^^^^j^,, ^^ bed any damp clothing isimmedi-<br />

Jy Henry Norris, M. I),, Kutlierfonlton, N. C,<br />

Surgeon to The Riitlurford Hospital,<br />

As the title <strong>of</strong> this paper implies, it has<br />

<strong>at</strong>ely removed and Until the p<strong>at</strong>ient has rejrained<br />

consciousness they are w<strong>at</strong>ched<br />

every moment by a skilled nurse who is<br />

do with the care <strong>of</strong> post oper<strong>at</strong>ive cases, competent to take the pulse intelligently<br />

>ut necessarily much <strong>of</strong> this care must be- and to note and record symptoms. When<br />

fin before the oper<strong>at</strong>ion, and I propose to morphia has been given beforehand and<br />

)riefly outline the methods used in The ether properly administered there is not apt<br />

ilutherford Hospital, prior to and after to be much nausea, when it occurs, how-<br />

>per<strong>at</strong>ive procedure. The day before opera- ever, it can <strong>of</strong>ten be relieved by raising the<br />

ion drachm doses <strong>of</strong> salts are given every p<strong>at</strong>ient's head a little or by giving inhalalour<br />

until the bowels have been freely<br />

noved. When possible the p<strong>at</strong>ient is given<br />

tions <strong>of</strong> vinegar or sips <strong>of</strong> very hot w<strong>at</strong>er.<br />

We expect the p<strong>at</strong>ient to complain <strong>of</strong> pain<br />

1 full b<strong>at</strong>h, followed by careful prepar<strong>at</strong>ion in the wound, which is usually <strong>of</strong> a burn-<br />

)f the oper<strong>at</strong>ive site. To insure a good ing character and passes <strong>of</strong>f in the course

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