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the normal oblique direction of the canal, its results are much inferior to simple suture of the pillars of the ring, for of 235 operations by the latter method relapses occurred in 29 (equal to 12.3 per cent), while in 53 by Bas sini there were 19 relapses (equal to 35.8 per cent); (g) the method of healing, first intention giving much fewer relapses than second (257 first with 39 relapses, equal to 15.2 per cent; 67 second with 15 relapses, equal to 22.4 percent). Sequela: Among the 324 cases atrophy of the testicle was found in 12 (9 times after simple suture of the pillars, equal to 3.9 per cent; 3 times after Bassini's operation, equal to 5.8 per cent), hydrocele of the cord in 3 and varicocele in 3.-British Medical Journal.
SALICYLATE OF METHYL IN ARTICULAR RHEUMATISM.-Siredey, who has made extensive study of the use of salicylate of methyl, gives some particular indications as to its use. He first remarks that salicylate of methyl is not to be confounded with essence of wintergreen, as is not infrequently done. This latter product is much less pure and has not the same active property as the former, besides having a most unpleasant odor and being more irritating to the skin. The method of application is simple. The part, having been washed, is laid upon a sheet of gutta-percha tissue. The salicylate is now applied directly on to the skin over the affected joint, drop by drop, and the gutta-percha tissue is immediately brought over so as to completely envelop the affected part. A fannel bandage is then applied in the usual way. A thin layer of cotton wool may be used in some cases if the patient does not find it disagreeable or hot. Should it be the hand or foot the part can of course be completely enveloped as described. It does not seem absolutely necessary, according to the author, to apply salicylate of methyl directly to the part affected, for, as in the case of the hip where the process of wrapping up to prevent evaporation would be difficult, it seems sufficient to apply it to the thigh immediately below, for the action of the drug is due to its absorption rather than to a merely local effect. The salicylate dressing may be renewed twice in the twenty-four hours if the pains are very severe, and the quantity applied may vary from 50 to 120 drops, according to circumstances. It does not seem to produce any unpleasant effect on the skin, merely a slight degree of redness being observed, which is painless and without irritation. In the case of acute polyarticular rheumatism the author finds the application of salicylate of methyl, as above described, to be well-nigh impossible. Under these circumstances he administers it internally in large doses. But in subacute and chronic cases where fewer joints are affected and these distally, salicylate of methyl seems to have extremely satisfactory results, being much more marked than those of salicylate of soda. The pains disappeared in two or three hours after the first application, and the author finds that cases which do not respond to this latter are at once relieved by the methyl. The existence of heart complications seems to be no contra-indication; thus the author has applied it in two cases of severe pericarditis, both of which
terminated favorably. The same treatment is recommended for gouty arthritis. In the case of infective arthritis the result was not so good, but in large doses a certain degree of benefit was obtained. It would seem that conditions other than rheumatic are controlled by salicylate of methyl. Thus the lightning pains of tabes, tubercular leprosy, Potts' disease, etc., have in the author's hands been much relieved by the application of this drug.-Ibid.
THE MENOPAUSE AND SENILE INVOLUTION OF UTERUS.- Parviainen (Mitheilung aus der gynak. Klinik der Professor Engstein, Vol. 1, Part II, 1897,) has issued a very complete monograph on senile degeneration of the uterus. Many of the histological changes are clearly morbid, and not always can disease be distinguished from natural atrophy. It is important to those who would lay stress on the microscope as a clinical agent to remember that Parviainen finds that while the cilia of the uterine and cervical epithelium grow scanty in sickly women near the menopause, they sometimes remain perfect in women over sixty where the uterine muscular tissue has undergone degenerative changes perceptible to the naked eye. This involution of the muscle is not easy to explain even after careful research, and Parviainen finds no evidence whatever that changes in the blood vessels play the first or most prominent part in bringing on active atrophy. Great care has been taken to distinguish between old women dead from general complaints, like typhoid fever, and those dead from local maladies least likely to affect the genito-urinary tract. Menopause histories have been carefully collected from 250 cases. Of early menopauses Parviainen found 2 in women aged 37, 2 where the age was 38, 3 at 39, 12 at 40, 3 at 41, 11 at 42, 6 at 43, and 8 at 44. Then follow high numbers, as might be expected, falling rapidly after 51. The change of life came on in 3 patients at 54, and in the same number at 55, and in one at 56, and the same number in patients of the age of 57, 58, and 59 respectively.-Ibid.
FOR THE RELIEF OF PAINFUL AFFECTIONS OF THE BLADDER, PROSTATE, OR URETHRA the following have proven efficacious:
R Morphin hydrochlor.,
In addition, should fever be present, the following is advised:
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COMPLETE EXCISION OF THE STOMACH IN A HUMAN BEING.
A stir in medical circles is occasioned by the announcement that Dr. Carl Schlatter, of Zurich, Switzerland, has successtully removed the stomach from a human subject. The first authentic account of this surgical triumph was a paper by Dr. Edward Charles Wendt, in the New York Medical Record of December 25, 1897. The patient's name is Anna Landis; age fifty-six years. Cancer is hereditary in her family. She had all the symptoms, subjective and objective, of cancer of the stomach. A tumor about the size of two fists, freely movable, was easily made out. The tests for free hydrochloric acid and the iodide reaction of the saliva were made and were found confirmatory of the diagnosis. The operation was done on September 6, 1897.
The author thus describes the procedure:
The stomach being diseased in toto, a gastro-enterostomy was impossible. I at once decided to attempt to excise the entire organ, or take recourse in a jejunostomy. I first freed the stomach from all its attachments at the greater and lesser curvature, having previously shut off the general cavity of the peritoneum by sterilized compresses. The omentum was incised between Péan's forceps. Silk sutures were used. The stomach was then forcibly dragged downward so as to enable me to reach the esophagus. The left lobe of the liver had to be constantly held upward by an assistant
in order to permit me freely to manipulate within the field of operation. In this way I finally succeeded in securing the esophagus rather high up, by means of a Wolfler clamp. A Stille forceps was next fastened closely to the cardiac end of the tumor. Then the stoinach was severed directly beneath the esophageal extremity. As the esophageal incision appeared somewhat oblique, I proceeded to place a small occluding suture at the gastric wound. The same steps were now repeated at the pyloric end of the stomach.
I next mobilized the duodenum, as far as possible toward the head of the pancreas. Then, having applied a duodenal compressor, and likewise a tumor clamp, I removed the entire stomach, between the two points of compression. I also dissected out the lymphatic nodes above mentioned. The patent lumen of the duodenum was treated like the esophageal opening with iodoform gauze. The broad bridge joining together different divisions of the alimentary canal had now been entirely removed.
I next tried to pull the duodenal opening upward toward the esophageal cleft. It was only with considerable difficulty that the two could be made to touch. It'was manifestly impossible to join them by direct suture. I therefore invaginated the duodenal rim, and closed the opening by a double suture. I then searched for a suitable coil of small intestine. Beginning at the duodenal-jejunal fold, I followed down the intestine for about fifteen inches. The presenting knuckle of the intestine I grasped, and, pulling it over the transverse colon, I placed it against the esophageal slit.
A piece of this intestine, about five inches in length, was secured between two Wolfler clamps. By means of sutures not going deeper than the serous coat, the intestine was then attached to the esophageal stump. A longitudinal slit about one inch in length was then made into the bowel. Then the mucous membrane of the esophageal end was firmly united with the intestinal mucous membrane, by a continuous circular suture. The material employed was silk. Above this, a second suture, extending through the muscular and serous coats, was introduced. A Lembert suture finally completed the stitching, which now seemed to hold.
The esophageal and duodenal clamps were then removed, the former having remained in position for over two hours. On dropping back the organs into the abdominal cavity, the sutured portions showed marked retraction upward, toward the esophageal part of the diaphragm. The abdominal wound was closed in the ordinary way by silk ligatures. Less than eight ounces of ether had been employed during the narcosis, which had fortunately been a very quiet one.
The operation lasted three hours and a half. The patient had at its close a steady pulse, 96 to the minute, and of fair volume. She steadily improved to complete recovery, "feeling quite well” and being able to walk about comfortably on the 25th of the following November.
Thus is chronicled an operation, which for surgical daring, and brilliancy of result, eclipses any thing yet accomplished upon the human subject. It is not in evidence that it required any more skill than Billroth's resection of the pylorus, or perhaps some of the brilliant operations in intestinal surgery done during the last decade by our best surgeons; but in the fact that Dr. Schlatter removed from the alimentary canal a hitherto supposed to be vital organ gives the operation a physiological importance that will stamp it as one of the major achievements of medical science.
The significance of the operation in this respect is thus considered by Dr. Wendt:
While it would be manifestly unfair to indulge in sweeping generalizations on the strength of this single case, so boldly rescued and ably described by Dr. Schlatter, it seems at least justifiable to formulate the following conclusions:
1. The human stomach is not a vital organ.
2. The digestive capacity of the human stomach has been considerably overrated.
3. The fluids and solids constituting an ordinary mixed diet are capable of complete digestion and assimilation without the aid of the human stomach.
4. A gain in the weight of the body may take place in spite of the total absence of gastric activity.
5. Typical vomiting may occur without a stomach.
6. The general health of a person need not immediately deteriorate on account of removal of the stomach.
7. The most important office of the human stomach is to act as a reservoir for the reception, preliminary preparation, and propulsion of food and fluids. It also fulfills a useful purpose in regulating the temperature of swallowed solids and liquids.
8. The chemical functions of the human stomach may be completely and satisfactorily performed by the other divisions of the alimentary canal.
9. Gastric juice is hostile to the development of many micro-organisms.
10. The free acid of normal gastric secretions has no power to arrest putrefactive changes in the intestinal tract. Its antiseptic and bactericide potency has been overestimated.