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

REVIEW OF SOUTHERN MEDICAI, LITERATURE.
there will be little or no extravasation.
After six hours have elapsed, peristalsis is
reestablished and extravasation occurs with
rapidly spreading peritonitis.
If operated on within the first six hours,
the result as illustrated in this eeries of cases
will be uniformly good.
After this the prognosis becomes more
unfavorable generally as the time fjrogresses.
As much rapidity in operating as
is compatible with careful work, free stimulation
and in the presence of shock and
hemorrhage, together with drainage and
Fowler's position, aid materially in the patient's
chance for recovery.
Richmond Journal of P>acticc, Junt\ 19ii9.
Surgery ol tbe Perlpberal Nerves.-
By Dr. J. S. Ilorsley, Richmond, \'a.
Atlanta Joiirnnl-Record of Medicine, July,
1909.
Tonslileclomy versus Tonsillolomy.—
Dr. H. II. Lokey gives the following decription
of the operation
After the patient is anaesthetized, if with
a general anesthetic, keep the mouth open
with a mouth gag, and with a tongue depressor,
placed well back of the base of the
tongue, expose the field of operation and
with Iceland's tonsil knife separate the
faucial pillars from the tonsil. Then with
a Marquis forceps, passes through the loop
of Farlow's snare, and with the tongue depressor
in the hands of my assistant, the
tonsil is drawn out towards the median line
and the loop of the snare forced well down
over the tonsil, being careful to avoid liav
iug the uvula within the loop. Then grasp
the snare with both hands and with one
grip remove the tonsil. The I'arlow snare
is supplied with a screw mechanism by
which it can be more slowly removed, but
do not use this except at occasional times.
After the operafion, wipe the blood from
the throat and inspect the field. If there
are any fragments of tonsil, left, remove
them with the Roberts' or Farlow's punch.
Then take a piece of wet gauze, wrap it
around the finger and make several sweeps
between the pillars across the raw surface.
This aids in freeing the wound from fragiits
of tissue and also assists in checking
the hemorrhage.
Pellagra.— Ur. E. S. Cross believes that
it is not impossible that further investigation
may show a relationship among these
similar conditions. Pemphigus, leprosy,
egotism and dermatitis venenata may have
to be eliminated Ijy the history and course.
Acute cases of pellagra are practically
always fatal I'atients in the earlier stages
of the chronic form may be entirely relieved
:
by change in diet. The outlook after mental
change has appeared is, of course, unfavorable.
Aside from removal of the patient from
unhygienic surroundings and the substitution
of a suitable diet, treatment is largely
problematical. Arsenic has, perhaps, met
with greatest favor and may be very well
given as atoxyl, hypodermically. Local
conditions are to be met symptomatically.
Iodine is said to relieve the burning and
itching of the skin lesions. Protargol in
doses of l-,5 of a grain daily has been advocated
for controlling the intestinal conditions
on the theory that an aspergillus, susceptible
to small amounts of silver may
play a part. Hydrotherapeutic measures
are useful to combat certain of the nervous
symptoms, but cases with chronic mental
change require asylum care.
Indigestion Due to Causes Commonly
Removable by Surgery Dr. E. G. Jones
says that of twenty adults complaining of
stomach trouble of chronic duration it is
perhaps conservative to say that twelve
have affections with which surgery has
nothing to do; the remaining eight have
( 1) appendicitis, or (2) gall stones, or (3)
ulcer or cancer, or (4) an obscure lesion
such as perineal adhesions, hernia, cecal
tuberculosis, etc.
If these persons are under forty the proportion
of appendix and ulcer indigestion
will be increased at the expense of the cancer
and gall stone indigestion; if they are
beyond forty the cancer and gall stone indigestion
will be increased at the expense
of the appendix and ulcer indigestion.
lught of the twenty, therefore, can be
offered no reasonable hope of a permanent
cure by medical measures. They can all
be offered much by surgery—except the
cancer patient, and of all visceral cancers,
gastric carcinoma is perhaps the most surgical
if diagnosed early.
/ 'irginia Medical Semi-Monthly, July 23rd,
1909.
Tbe Influence of Sleep on Arterial
Sclerosis.— Dr. \V. W. Beveridge points
out that where individuals are so situated
that sleep is impossible, as soldiers on the
march, or sailor at sea in a storm, an unusually
long period of sleep is necessary to
compensate for the long delay. Not only
does this pertain to the human race but to
animals as well, for all know that animals
well housed and worked only during regular
hours and with regular hours for sleep,
require much less feeding and do better
than those otherwise attended.
This theory has economic value only in
so far as it can be applied to every day life.