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

ORIGINIAL COMMUNICATIONS. .'iS?
is commenced about one-c|uarter inch from ance coming on during the course of chronic
the marsin of the wound and on a level alcoholism and is due to accumulation of
with the posterior commissure. It passes toxic poison in the blood. These poisons
throu.^h the skin and underlying tissues, are of both drug and auto-origin. The pomaknig
a sweep outward, and is carried tency of these poisons is progressively inthrough
the levator ani. It is then carried creased bv a loss of the fluid element of the
m the direction of the anus, but great care blood bv excessive perspiration and by demust
be exercised not to pierce the bowel, ficient absorption of water from the stomana
in any case of doubt, one finger of the ach. In fully developed cases the volume
gloved hand should be introduced into the of circulating medium is pathologically debowel
as a guide. The suture is then creased. The brain is hyperemic in a large
brought out on the other side in the same majority of cases and eiiemic in a small per
manner. Two, or at most, three such su- cent. These conditions of the brain is an
tures effect proper apposition. essential factor in the immediate causation
We have now, only to consider tears in- of the delirium. In order to intelligently
volving the sphincter ani. For the purpose apply remedies to the control of delir?um it
of approximating this muscle, two silk- is necessarily to differentiate the hyperemic
worm-gut sutures are used which commence from the eiiemic cases.
on the skin, pierce the muscle and skirt The indications in treatment are, support
under the tear and come out on the other of vital fuctions, control or arrest of delirium
side in the same manner. The most im- and removal of poison from the blood.
portant point, however, is to protect the For the purpose of restoring the volume
suture line from infection from the bowel, of blood, supporting action of heart and
This may be accomplished in several ways, promoting elimination by kidneys normal
The easiest is to pass a third suture, skirt- salt solution is given by' rectum^ by hypoing
along just under the mucous membrane dermoclycis, and in severe cases intravenof
the bowel. When this is tied, it draws ously. This is pushed until the entire ardowii
the mucous membrane like a purse terial and venous system are filled with
string and acts very nicely. The mucous fluids to their utmost capacity, then, this
membrane may also be dissected up suffi- fluid is drained off by the bowel with large
Ciently to draw it down, when it is sutured and repeated doses of epsom salts, the idea
in this position transversely at the margin being to practically wash the poison out of
pi the anus. In ca.ses, where the tear ex- the blood by forcing fluids into the system
lemls up so high as to involve the septum, and draining the same off by the bowel and
|t will be necessary to suture the mucous kidneys. Calomel is given in full doses at
jnembrane with catgut in situ, and, as a the beginning of the treatment. Sparteine
rule, il heals very rapidly without infec- in doses of two grains is given every two to
pion. six hours for the purpose of giving addi-
I Tiie after care of the bowels is of great- tioiial support to the heart and promoting
;st importance. If the suture line is pro- action of kidneys. This remedy is classed
acted by mucous memarane as indicated, as our most reliable heart tonic and an eiBhere
is no reason why the bowels should cient non-irritating diuretic.
lot be moved early. Consec|uemly, I en- The free introduction of normal salt soluiea\nr
to secure a fluid stool on the third tion gives most reliable support to the heart,
lay by the administration of a saline. I dilutes and renders less toxic the poison in
)elieve that prolonged constipation is inad- the blood, improves the condition of the
isable, Wliere a large, hard, fecel mass patient in every respect and does much to
s formed, I do not believe it can be broken allay the delirium, but for the special purip
by any form of medication; and its pose of combating the delirium, in the hy-
>assage is very apt to cause very serious peremic cases, Ciolseminine is given in doses
rijury to the recently repaired muscle. of 1-2,5 grain every one to two hours until
The after care of tlie perineal wound is its full physiological effect is developed,
imple. The patient voids, and after each unless the delirium and unrest is sooner
oidiiig and bowel movement, the external allayed. This drug is a reliable cerebral
are bathed, and dusted with boric- sedative and motor depressant and is not
cid i)o,vder. Tlie stitches are removed on incompatible with drug indicated in the
lie tenth day. . hyperemic type of cases but should not be
3 west Grace Street. given in the anemic cases. Strychnia, a
~
drug, the effects of which are directly oppo-
Dellrlum Tremens-A New Plan ol site those of Gelseminine, is given for the
reatmcni.— Geo. R. Pettey, M. I)., Mem- control of the delirium in the anemic cases.
his, 'I'enii., at a recent meeting of the Strychnia is positively contradicted in the
outliern Medical Association, said. This hyperemic cases, but in the eiiemic cases,
dilion is defined as a functional disturb- by increasing the blood supply to the brain