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

REVIEW OF SOUTHERN MEDICAL LITERATURE. 49
good. Such a clinical picture with the
physical signs of a central attachment
pulse that is weak.
In chronic conditions a pulse rate of more
should by all means receive this form of than 120 should contra-iudicate operative
form of treatment. Under all other condi- work, but in acute conditions, where the
tions the author would prefer to empty the operation is little more than opening an
uterus per vias naturales. To accomplish abscess, a patient may be a good risk with
this the cervix and lower segment must be a pulse of more than that rate. Patients
dilated or incised according to the method with a normally slow pulse of say forty to
of Duhrssen. fifty, if regular, make good risk.
AH conditions of the heart that show in-
The American Practitioner and Ne-ccs, May, competency should contra-indicate operal()i>9.
tion.
Gun-Shot Wounds ol the Abdomen witb
Special Rclcren ce to Injuries to the Ali I'irginia Medical Semi-Monthly, May 7t/i,
mentary Tract.— Dr. F. W. Sammuel points 190'^.
out that perforation of the intestine by gunpej^sonal
Experiences in Prostatic Surshot
missiles are followed by extrusion of
^3, I^ e. Brvan calls attention to a
the mucus membranes, rosette-hke ,n approstatectomv
as a radical cure
-
pearance. Th.s effect is caused by the re-
^ ^
.
,^„i^,^i
dundance of the mucus membrane and by J ^
»
^^^ ^^^^.
spasm of the circular fibres. n some pergonorrhea
ten years a^go. Since
forations . ,s no so noticeable Wounds "
innumerable outbursts
mace by the bullet passing tl^rough |e
.Uaracterized bv severe discharge, frequent
walls of the gut parallel to Its long axis he
urination and relapsing epimucus
membrane IS earned away and his
jidymitis or epididvmoorchitis. The proseffect
does not occur It is also absent 111
moderatelv enlarged, boggy and
wounds of he stomach and large 11 est ne.
'expressed on each oc-
Uounds of the intestine do not bleed so P
,gonococci
and brokenfreely.
likewise the solid viscera, he most
,i„,,„ p.^^ucts. Sitz tubs and rectal irrigamsignificant
artery when severed, under
^ religiously carried out at each
the innuence of intra-abdominal pressure
untif wearied with the frequency
will bleed continuously, and the shock
^f ^^ attacks and understanding that the
which IS significant 11. a 1 peritoneal wounds
^^^^^^ ^^ .^^^^^^.^^^ ^^,^^ ^,^^ ^^^^^^^ ^1^^^ j^
brings about the wel -known fact o vis-
.^aHzing the severitv of the operation, he
ceral engorgement, which consequently en-
^^.-^y {I. subjected " himself to any radical
courages hemorrhages.
procedure which he thought stood a fair
The Conditions which Modify Opera- chance of bettering, probably curing, his
live Work.-Dr. A. D. Wilhuoth says that
trouble. (Jii March 1st, by perineal section
lesion of the mitral valve with a moderate
(1,^ prostate was most satisfactorily removmyocarditis
take anesthetics well, other
^j The patient left the hospital at the end
things being equal, while aortic lesions with
of the fifth week; the wound had entirely
advanced myocarditis should be looked on
],eaied. Daily irrigations of a mild soluseriously.
The surgeon should withhold ^^^^^ ^f permanganate of potassium have
his opinion until the kidneys have been
,,gg„ earried out and, at present, there is
carefully examined and the blood pressure
;ii,solutely no discharge, the patient retains
taken, for in the first instance those with
j,jg y^ine throughout the night and from
marked lesions that can be heard easily
f^ur to five hours during the day, and has
with little or no kidney complications make already gained much in weight and spirits.
a good risk, and in those of more advanced 'j-he focus of the infection having been rekidney
complications, if it is shown that moved, the writer believes this patient to be
the cardiac action and the volume of the
,m,ch better off than it would have been
pulse at the wrist are in direct relation to
possible ever to have accomplished by medieach
other, we are safe in saying that the
^..jtion, instrumentation or washings,
patient has a sufficient cardiac force to ,.„... ^
stand the extra strain that will be placed Intestinal Perforation in Typhoid
upon it in doing an operation of ordinary Fever. -Dr. C. C. Teniiant believes that
severity. If the heart's action is tumul- the diaggosis should be based mainly upon
tuous and the pulse weak at the wrist such the sudden sharp pain, followed by tenderpatients
should be regarded as bad risk and ness and rigidity, the latter being the most
operated on onlv as life-saving measures, important, and seldom absent. Besides
The heart should be examined for regu- these, we may have more or less shock, fall
larity. Irregular pulse is far more serious, of temperature, an increase in the pulse
even though it be strong, than a regular rate, or the patient may perspire, shiver, or