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

178 THE CHARLOTTE MEDICAL JOURNAL. i
tic acid bacteria is dependent on their de- has been done and the trouble recurs, it is i
struction of the bacteria of fermentation in not muscle which is found covering the sac; j
the stomach and intestine. They are ad- what is found is merely the fibrous remains !
ministered in the form of bouillon. Intes- of the stretched union, the muscle having |
tinal irrigation is less used than formerly, receded to a point above the level of the •'
The only medication that seems of value is canal. Had the muscle been sound and a
opium, to control vomiting nnd stools, and active, and had it remained in close appo- ,
gelatine. The intestinal antiseptics seem sition to Poupart's ligament, recurrence :<
of little real value. Gelatin causes lessen- would have been impossible. It is there- t
ing of the number of stools; the green color fore clear that to get a permanent result .;
disappears, the bad odor ceases, and the which shall honestly reserve the term "rad- >
acid reaction passes away. It is adrainis- ical cure," a term hitherto much misused,
tered in a warm sterilized solution, with is not by any means so simple as it would
care not to give cold drinks at the same at first sight appear. Bassini's operation,
time. when done early iu the history of a hernia
and followed by sufficiently protracted con-
Inguinal Hernia.- McGavin in The Brit- valescence, is an excellent operation in
ish Medical Journal says that the complete most cases; there are others, however, in
and permanent cure of inguinal hernia de- ^hich it fails to meet the requirements of
pendson: (a) The total abolition of the madern surgery, and these may be said to
peritoneal sac or sacs; and it must be re- ^g the following: 1. Those of inguinal ''
membered that one of these may be thick hernia in elderly subjects. 2. Those in
walled and perfectly obvious, while another ^dult life where the strain of certain occu- '
may be present which is of the most ex- pations is so constant and severe upon the ,
treme tenuity, difficult to find, with a lumen abdominal walls, that it is unreasonable to
only admitting a probe, and yet quite capa- '
expect a cure when treated by the ordinary
bleofenlarging one day to greater capacity, methods. 3. Those in which, although in i
(b) The permanent approximation of the young subjects, the muscular structures of I
muscular structures of the inguinal canal ^^e part are found at time of operation to I
to Poupart's ligament, (c) The mainten- '
^.g t^j,!^ jjadly developed, or stretched and
ance of the histological character of these loose over a large area. 4. Those in which i
'
structures by careful operative technique the hernia has recurred, especiallv if after
and by the subsequent employment of prop- ^ carefully carried out operation followed i
erly regulated physical exercises. And (d) by a primary union. 5. Those in which ;
on the prolongation of convalescence in the the hernia is of such size that the gap can- i
recumbent position for a period much '
be- not be closed without the exercise of such
yond that which is usually accorded to tension as to produce strangulation of the |
these cases. It is easy to see that while the structures within the grip of the sutures—a I
first and fourth of these essentials present condition which is one of the most certain j
no very great difficulty, the second and of all the predisposing causes of recurrence. >
third are not so simply attained. The gap
to be covered may be enormous; the mus- Diphtherias with Invisible Location
culature may be attenuated, friable, and (Crypto-Hiphthcrias).— Abrand (Ann. de
fibrous, and thus it may be that the whole Med. et Cliir. Inf. ) calls our attention to
inguinal canal presents such a wreck that the occurrence of cases of diphtheria
the possibility of a cure seems quite out of which the membrane is not visible, yet
the question. In other cases, although the which have the characteristic diphtheria,
structures may be in fair condition, the syndrome. In these cases the membrane
amount of dissection required to accomplish may exist in the nasopharynx, larynx,
the approximation, especially in old stand- bronchial tubes, trachea, or esophagus,
ing and recurrent cases, and possibly the These locations are quite frequent in cases
tension necessary to keep muscle and liga- of the ordinary diphtheritic angina, but are
ment in accurate contact, are such that, most important when the membrane
within a few weeks of the operation, what not appear on the pharynx and tonsils, the
was muscular is reduced to fibrous tissue, usual locations of membrane. Such caseg
Now the muscle which is brought down is are liable to be diagnosticated late in the'
brought down with a very definite object; disease, after the poison has had a chanc
its purpose is not merely to block the canal to act on the general system, and are liable
passively by its presence (the peritonaeum to paralytic and heart complications as th«
and the abdominal aponeurosis would of first symptom noticed of the action of th(
themselves do that), but by its active con- diphtheritic poison. He calls them crypto
tractions to tighten up the walls of the diphtherias. He describes six cases whid
canal without suffering permanent loss of came under his observation. They shoM
elasticity in doing so. When an operation how important it is to make a careful ex
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