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sarily increase the existing shock. Gastrostomy, however, might Buy Generic Viagra Europe be performed under local Buy Generic Viagra Europe anaes- thesia, and it had certain indications which were at least theoretically logical. Dr. Robert T. Morris said that we had to ac- count for several features of acute gastric dilata- tion along some of the newer lines of knowledge. With this condition we had, following the initial disturbance, increased peristalsis and antiperistalsis, and an extreme degree of secretion of morbid character. Shock, ether, and to.xines were all known to derange secretions of the chromaffins, and if these products of deranged secretion over- stimulated the inhibitory nerves of the stomach, it would result in practically the same effect as cut- ting the vagus, so far as the phenomenon of dila- tation was concerned. If the hormones secreted in the mucosa of the stomach were at the same time disturbed in action, they might overstimulate secre- tion of the stomach cflands. and that would account May 6, 1911] PROCEEDINGS OF SOCIETIES. 905 for the excessive quantities of fluid in the stomach in these cases. The fluids attacked by saprophytes, in the absence of normal protection, would undergo fermentative changes, and that would account for the gas which was produced in such quantity. Dr. MoRRi.'^ believed that while shock, ether, and toxines could all disturb the cerebrospinal system, with consequent suspension of vagus action, this system, as a later development of Buy Generic Viagra Europe the embryo, was probably more resistant than the primitive sympa- thetic system, and it was to the latter that we were to look for an explanation for the phenomena of acute ijastric dilatation. Dr. Lee's case of acute gastric dilatation following the receipt of a small superficial burn of the abdomen was particularly significant as relating to this view. With a burn, some of the albuminous tissues were transformed into tcxalbumin. It looked as though the toxalbu- min, absorbed, had overstimulated the inhibitory nerves of the stomach by way of deranged chromaf- fin secretions, and had secondarily induced the hor- mones to stimulate the secretory glands of the stom- ach to the point of forming great quantities of ab- normal products. Practical treatment of cases of acute gastric dila- tation consisted of two chief resources, and these were very effective in giving relief. If the patient was placed upon the abdomen, bearing rather more upon the right Buy Generic Viagra Europe side, we had mechanical compression of the dilated stomach and unkinking of duodenal angulation. If the stomach was then washed out every hour or two with the stomach tube, the de- composing stomach Buy Generic Viagra Europe contents, with their poisonous saprophyte products, were removed. The patients then commonly went on to recovery in a few days. Dr. Robert Colem.\n' Kemp said that in all the six cases of postoperative acute dilatation of the stomach he had seen there had been considerable manipulation of the abdominal viscera. In this acute dilatation the stomach was generally not alone concerned. According to his experience, there were four types Buy Generic Viagra Europe : The pure gastric, the gastroduodenal, Buy Generic Viagra Europe the gastrointestinal, and that in which there was an acute dilatation engrafted on a stenosis of the py- lorus with chronic dilatation. The diagnosis must be made by means of the aspirating bulb and stom- ach tube; the gastric contents being first aspirated and the stomach then washed out. If, after the stomach had been completely emptied, the intestines were found to be still dilated, the case would be seen to be one of mixed type. Acute dilatation was especially liable to occur after Caesarean section. If a case was purely gastric in character, the pa- tient should be placed on the right side or belly, and the stomach be thoroughly washed out every two hours. If it Buy Generic Viagra Europe was of mixed type, resort should be made to the Fowler i)Osition. The medication Buy Generic Viagra Europe employed by Dr. Kemp consisted of calomel, mag- nesium sulphate, strychnine, and eserine, as well as laree doses of belladonna. He never used mor- phine and considered it harmful. No food should be given by the mouth, and proctocylsis should be employed for thirst. Continuous enteroclysis with normal saline solution, at a temperature of from 11^° to 120° F., for from thirty to forty minutes, by means of a recurrent tube, was of great value in helping to start bowel action. In the mixed cases this also relieved intestinal tympanites. Dr. A. Ernest G.-mxant said he had seen a dozen cases since 1906, when he first met with this con- dition, and he had found that the dilatation usually came on three days or more after the operation. In his experience, the patient seemed to be doing well at first, but later there came on a sort of over flow vomiting. Sometimes a pint or a quart of fluid was • spilled over, and very soon the vomitus became of a dark green color. A study of the 200 or 300 cases on record seemed to show that the origin of the dilatation was chiefly mechanical, and personally he believed the cause of the trouble to be mechani- cal compression of the duodenum as it passed be- hind the mesenteric vessels, as described by Byron Robinson. After this condition had been estab- lished the toxsemia portrayed by Buy Generic Viagra Europe Dr. Morris no doubt prevailed. In the treatment he relied princi- pally on posture and washing out the stomach with Buy Generic Viagra Europe srallons of water. He had found it much simpler to practise lavage with the patient lying on the left side, though later it was well to turn him on the other side. He did not believe the intestines were involved in these cases, for if this was so we would have peritonitis ; and no peritonitis had been noted. Dr. Achilles Rose said that acute dilatation sometimes occurred in cases where there had been no operation, in patients who had previously had ga.stric dilatation in connection with Buy Generic Viagra Europe pyloric steno- sis, and the acute attack appeared to be due to the cutting olT of the compensation which had existed.