Contributions to surgery and medicine: Intestinal disease and obstruction ..., Part 1

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H.K. Lewis, 1883 - 284 pages
 

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Page 34 - For the last thirty years I have made it the rule of my practice in the treatment of typhoid fever to abstain from giving alcohol if, in the case before me, I doubted the wisdom of giving it; when in doubt I do not give alcohol in typhoid fever, and when there is a question in my mind of a larger or smaller dose I, as a rule, prescribe the smaller. The reverse of the rule I laid down for myself in the treatment of typhus fever.
Page 164 - That the chances of successful treatment, -whether by the use of bougies or by the injection of air or water, are exceedingly small, excepting in quite recent cases, and that if the surgeon does not succeed by them promptly it is not likely that he will succeed at all.
Page 164 - ... to form an opinion as to whether the intestine is strangulated or simply irreducible. 8. That in cases of strangulated intussusception, whilst there is great risk of speedy death, there is also some hope that gangrene may be produced and spontaneous cure result. 9.
Page 33 - I may sum up my experience in regard to the use of alcohol in the treatment of typhoid fever thus. Its influence is exerted primarily on the nervous system, and through it on the several organs and processes ; for example, the heart and the general nutritive processes — changes on which the rise and fall of temperature depend. In judiciously selected cases it lowers temperature, increases the force and diminishes the frequency of the heart's beats ; it calms and soothes the patient, diminishes...
Page 165 - That in cases in which the patient's symptoms are very severe, or the stage greatly advanced, it may be wiser to decline the operation, and trust to the use of opiates. 17. That the operation is best performed by an incision in the median line below the umbilicus, 18. That in cases of intussusception in young infants (under one year of age) the prognosis is very desperate, scarcely any recovering excepting the few, in whom injection treatment is immediately successful, whilst a large majority die...
Page 54 - And when any part of the intestine has its cavity obliterated by an immovable mechanical obstacle, its contents, propelled by such a peristalsis, are stopped at the obstructed point. Here they gradually accumulate, so as first to fill, and then to distend, a variable length of the canal, with a more or less liquid mass. But a peristalsis, engaging the wall of a closed tube filled with liquid, and falling short of obliterating its calibre, sets up two currents in that liquid : one at the surface or...
Page 163 - ... part through the abdominal wall. 4. That the prognosis of cases of intussusception varies much ; first in ratio with the age of the patient, and secondly with the tightness of the constriction. 5. That in a large proportion of the cases in which children under one year are the patients, death must be expected within from one to four or six days from the commencement.
Page 31 - ... empty, and therefore nourishment should be given in the most concentrated and absorbable form, eg essence of meat in tablespoonful doses frequently repeated. All nourishment which leaves solid residue — eg milk — should be avoided. Lumps of ice should be sucked, and all essence of meat, etc., be iced. When the loss of blood is sudden and copious, or is frequently repeated, the subcutaneous injection of ergotine may be employed, and an ice-bag applied over the region of the ileum. The faintness...
Page 34 - In the fourth week, to tide the patient over the concluding days of the disease, it may, as a rule, be given more freely than, in the second or the beginning of the third week of the disease, but it is in exceptional cases only that more than twelve ounces of brandy in the twenty-four hours can be taken without inducing some of the worst symptoms of prostration. Nearly all the good effects of alcohol, when its use is indicated are obtained by four, six, or eight ounces of brandy in twenty-four hours....
Page 170 - October 24th, when about nine o'clock in the forenoon she obtained a pair of large scissors, that had been accidentally left in the hall, which she took to her room, and with which she made two wounds in her abdomen, one about an inch and a half above the umbilicus, the other half an inch below it. From the upper opening she took out part of the small intestines, from which she cut off a portion, seventeen inches in length, when she was discovered by another patient, and alarm being given, she was...

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