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

218
THE CHARLOTTE MEDICAL JOURNAL.
geon is able to meet any emergency, should One other remark in regard to this opera- !
such occur. It has always been my en- tion, and that is to say that results will al- i
deavor to impress upon the laity, and the ways be better when the same is performed I
profession also, that this is not a simple during warm weather. In fact, I think
operation if done thoroughly, but requires that only operations of urgency should be i
the greatest skill and manipulative ability, performed on the nose and throat in cold I
I have frequently heard other larj'iigologists weather, if we desire the best results. i
of prominence and ability say that they In conclusion, allow me to express my- 1
considered the dissection and removal of self again by saying that this operation is
the faucial tonsils one of the most diflScult the most beneficial of all in the domain of
operations which they were called upon to pediatrics, and if performed early and thorperform.
oughly will make the majority of children
If the operation is done early, when the strong and healthy for all future life. '•
child is young, the one great danger, that Grand Opera House. |
of hemorrhage, either primar>' or secondary, , |
is obviated, for almost without an excep- Accuracy In the Diagnosis ol Diseases \
tion those cases of severe or even fatal *** **•* Chest.* i
hemorrhage, which have been reported as By Lewis M. Gaines, B S., M. D., Atlanta, Ga., j
following the removal of the tonsils, have '^'^-^:^^-^^::^Xi^n^-'' '
occurred m adult patients. We must ex- pjtai; chief Medical Clinic Atlanta
cept in this statement those cases of hemor- School of Medicine; Associate Di-
rhagic diathesis.
rector Peachtree Heights Sana-
Only a few words in reference to the
torium for Treatment of
-.
. , r Tuberculosis. I
operation itself. . ,.•
, c
I prefer that this be done in a hospital Accuracy is one of the essentials of suewhere
the nurses and assistants know your cess in every calling. To the physician its I
methods, and where proper illumination value is beyond estimation, both for his own j
can be had for the field of work. This, of sake and that of his patients. Accuracy ,
course, can be done at home, and in cases presupposes both knowledge and skill, for
't is
of adenoids alone is quite as satisfactory,
a trait impossible of attainment by the
I always desire the patient to be placed ignorant and unskilled. But, alas! the
thoroughly under the anesthetic, and pref- possession of knowledge and skill by no i
ercbly ether, as the records show that it is means implies the attainment of accuracy 1
the safer. One must have good illumina- but necessitates the virtues of honesty and ]
tion, so as to see exactly what you are do- patience. A hasty examination because ':
ing. A mouth gag is used, and I prefer the waiting-room is full, a diagnosis based |
on conjecture rather than accurately ascer- \\
one of the Murdock varietv. I prefer the
patient on his or her back, although some Gained facts—these are temptations and j|
of the best operators prefer the patient in
faults which account for many failures, and .!
the upright position. The assistant stands which too often react upon the patient to ;,
^''^ detriment. Such failures are far less
j
on the left side, ready with sponging and
the tongue depressor. The tonsils are dis- excusable than those of honest ignorance. ;,
sected from the anterior and posterior pillars. Aside from ethical considerations, how-
pulled out of their beds with the tonsil for- ever, I desire to urge the importance of j
ceps, a snare or tonsilHtome passed over the accuracy m the diagnosis of chest diseases ;
latter, and the tonsil in this way thoroughly ^or the following reasons:
removed. If any remnants of the tonsil 1- Because of the frequency of diseases i
should be left on accoudt of its being soft of the chest. A far larger percentage of the j
and friable these can be removed by means fiuman race die directly or indirectly of :,
of the Hartmans' tonsillar punch. The l^^art and lung diseases than of diseases of
child is now turned so that the face hangs any other portion of the body. All honor
oyer the left side of the table and all bleed- to surgery and the magic advances she has
ing allowed to cease, which it usually does ^lade in the past half century, but except I
in a very few minutes, after which the ade- "i comparatively rare instances surgery is :
noids are then removed. I prefer the powerless to influence in the slightest de- j
Brandegee forceps followed by the curette, g'^e those affections of the chest which j
and finally with my finger wrapped with carry off such a very large proportion of !
sterile gauze. After all bleeding has ceased mankind. It is from the physician rather .j
the child is put to bed on its abdomen with than from the surgeon that aid must come
its head turned on one side, so as to allow and it can only come through the portal of the escape of blood and mucous. In twentyil
a correct and early diagnosis. j
|
four hours, if there is no fever, the child 2. Perha ps the most potent reason for
may be taken home. *Read before the Georgia state Medical Associa-
Liquid diet is ordered for thirty-six hours, tion at Macon, Ga., April 22, 1909.
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