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

ORIGINAL COMMl'NICATIONS. 149
sentially an operative surgeon. The skilful night's sleep, Trional grs. x is always
diagnostic surgeon no longer operates for given. In the morning the patient receives
every tumor, benign or not, as it comes, a simple enema of soapsuds and a second
because the tendency of modern surgery is preparation. We always begin to operate
more conservative than ever before. Radi- as early as possible in the morning, as by
calisra is becoming a thing of the past and so doing the patient is saved the nerve rackis
rapidly fading away before the greater ing waiting and often the tearful farewells
and more exact knowledge of the surgeons of the family; the surgeon and the nurses
of today. But I do say, that because of are cleaner than later in the day. It is all
lack of thorough study of the cases, jointly, important to have a skilled anpesthetist at
many cases of ovaritis, abdominal neuroses one's command who is to be trusted with
and appendicitis, if you please, are oper- the administration of nitrous oxide gas,
ated upon when they are not those diseases,
but are reflexes from some other cause,
ether, chloroform or ethyl chloride as we
may elect; who will reassure the nervous
Furthermore, when we get this exact cooperation,
we will not make these mistakes,
patient and gain their canfidence as well as
attend to the various pre-anaesthetic details,
because we will then know, for instance,
how much neurotic element there is, and
how much real pelvic pain. In other words,
such as seeing that the table is properly pre-
pared and that the patient is sufficiently
clothed and covered. It is our practice to
we can sort out and deal with the evidence invariably give a hypodermic injection of
of pelvic pain, and the physician can help morphine sulphate gr. 1-8— gr. 1-4 fifteen
the surgeon in his desire to be conservative minutes before the aneesthetic is commenced
and constructive, and not radical and de- and it is better in patients who are nervous
structive.
In conclusion, I believe that all of us,
to anesthetize them in bed and carry them
to the operating table. My own preference
[physicians and surgeons, wish and strive is for ether as the ansesthetic of choice
iOnly for the best results for the patient, but though I have used scopolamine-morphine
in our desire to be onesided, and all-power- anaesthesia in some fifty cases with excel-
ful, as it were, we run off too much into lent results and I believe that its use is inspecialties,
and wander away too far from dicated in certain cases. No time should
each other. We should come back and get be wasted by the surgeon when the patient
closer together, both for our own and for is brought in the operating room and his
the patient's benefit. Many a time the sur- procedures should be as rapid as is consistgeon
may m.ike an anatomical cure, may ent with good, clean, thorough work, as
remove a p ithological lesion, but even then shock is unquestionably increased by oper-
it is just as necessary and just as essential ations unduly prolonged, just as nausea is
that the referring physician should continue increased by large amounts of ether. It is
to treat the patient before a permanent cure not at all uncommon in some of the large
can be effected, for many of these cases re- clinics connected with teaching institutions
quire not only the treatment of the lesion, to see a patient fully anaesthetized and kept
medically or surgically, but also the medi- waiting for ten or fifteen minutes whilst the
cal and psjchic treatment of the patient, surgeon talks, or to see him stop in the
and to get the best and most lasting results midst of his operation to explain or dilate
we must have, even unto the end, hearty upon some condition which he wishes to
:o-operation, and an united interest, both make clear. Except in those cases recjuirn
the primary diagnosis and succeeding ing drainage I use a very small, light dress-
;reatment, on the part of both physician ing, consisting of about four thicknesses of
ind surgeon. . gauze, secured by narrow strips of zinc-
The Care ol Post Operative Cases.
oxide adhesive plaster. On the patients'
^^^^j^,, ^^ bed any damp clothing isimmedi-
Jy Henry Norris, M. I),, Kutlierfonlton, N. C,
Surgeon to The Riitlurford Hospital,
As the title of this paper implies, it has
ately removed and Until the patient has rejrained
consciousness they are watched
every moment by a skilled nurse who is
do with the care of post operative cases, competent to take the pulse intelligently
>ut necessarily much of this care must be- and to note and record symptoms. When
fin before the operation, and I propose to morphia has been given beforehand and
)riefly outline the methods used in The ether properly administered there is not apt
ilutherford Hospital, prior to and after to be much nausea, when it occurs, how-
>perative procedure. The day before opera- ever, it can often be relieved by raising the
ion drachm doses of salts are given every patient's head a little or by giving inhalalour
until the bowels have been freely
noved. When possible the patient is given
tions of vinegar or sips of very hot water.
We expect the patient to complain of pain
1 full bath, followed by careful preparation in the wound, which is usually of a burn-
)f the operative site. To insure a good ing character and passes off in the course