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enterostomy at the san.ie time. The peritoneal toilet is completed by carefully sponging out all fluid and foreign substances that have escaped from the stomach, or the upjier and lower abdomen may be irrigated with warm Viagra Generic Launch Date normal saline solution and 904 PROCEEDINGS OF SOCIETIES. [New York Medical Journal. svphoned with tubes after the method of Blake. A stab wound is made in the suprapubic region and a tube inserted into the pelvis for drainage below. The upper and lower Viagra Generic Launch Date wounds are connected by a split drainage tube threaded with gauze, inserted along the ascending colon. The tube may be divided in the middle and united with a couple of fine catgut sutures that will soon absorb and allow the tube to be withdrawn more conveniently in both directions. The after treatment is the treatment of peritonitis in such cases. Elevate the head of the bed, or sit the patient up in the Fowler position ; give no food by the mouth until the peritonitis subsides, the ice coil on the abdo- men, if necessary, and no morphine after the patient leaves Viagra Generic Launch Date the operating table. The percentage of recoveries diminishes rapidly as the time of operating is delayed after perforation has taken place. Few cases recover if surgical assistance is withheld for forty-eight hours. |r0rwMngs 0f 30ritti«s> THE MEDICAL ASSOCIATION OF THE GREATER CITY OF NEW YORK. Meeting Held February 20, igii- The President, Dr. Reynold Webb Wilcox, in the Chair. Acute Dilatation of the Stomach Following Surgical Operations. — The Viagra Generic Launch Date first paper of the evening, on this subject, was by Dr. Edward Wal- lace Lee. He said that while infrequent, this was one of the most serious complications which might follow any surgical procedure. It was more liable to occur after operations in the abdominal or pelvic cavities, and its early recognition might prevent a fatal termination. Usually the dilatation came on within twelve or fourteen hours after the operation, and in one instance he had observed it within an hour after the patient had been placed in bed. The literature and general discussion of this subject had been altogether too limited, he thought, for a con- dition of such importance and one which so often proved fatal (in seventy-five per cent, of cases), and this was the chief reason why he presented it. As to the aetiology, his experience had not been such as to enable him to determine upon any one definite cause. Various theories had been suggest- ed, but experience had shown that this sequela may follow different surgical procedures, regardless of the anaesthetic or the location, extent, or character of the operation. Many mechanical causes had been mentioned, such as spasm of the pylorus, volvulus of the stomach, kink in the duodenum, and pressure on tlie mesenteric vessels, but he did not wish to speak particularly of this class, since such causes, if Viagra Generic Launch Date present, were self evident. The question had been raised whether the condition was due to a neurosis, producing paralysis, and thus permitting the enormous formation of gases, or to an irritation continuously producing gastric secretion in excess. From his own observation he was inclined to look upon it as due to a neurosis, some serious vaso- motor disturbance, rather than to any direct irrita- tion of the stomach itself. The earlier symptoms were apparently those of shock, that extreme kind of shock accompanied with intolerable vomiting. The respirations became frequent and shallow, the pulse rapid and thready. The patient looked as Viagra Generic Launch Date if he had aged suddenly ; his extremities were cold, Viagra Generic Launch Date and his skin clammy. Nearly always the urine was scanty. On inspection and palpation the stomach Viagra Generic Launch Date was found Viagra Generic Launch Date to be enormously distended and usually sharply bent upon itself. The distention, extending toward the left, and perhaps causing even bulging of the ribs, pressed upon the diaphragm and inter- fered with the heart's action. He emphasized the distention toward the left because on the right upper abdomen there Viagra Generic Launch Date was apt to be flatness on per- cussion, and this was an aid to the diagnosis. Of a number of cases he had seen Dr. Lee re- ported five. These, with one exception, were in males between the age of forty-three and seventy. Only one of the patients recovered, and in this in- stance the dilatation came on after an operation for hernia. The second case was a gallbladder case, the third a suprapubic prostatectomy, and the fourth a cystotomy. In the fifth case, in a woman of twenty-si-x, the dilatation followed, not an opera- tion, but a burn, and he said he cited this case be- cause it tended to carry out the idea that acute gas- tric dilatation was of nervous origin rather than due to mechanical irritation of the stomach. Here the dilatation developed three hours after the recep- tion of the burn, which was on the upper abdomen and about six inches square, and nine hours later the patient died. In the treatment the speaker said that mechan- ical irrigation was primarily indicated. Even after thorough evacuation, the stomach would often refill, not only with secretion but with gas, and therefore it was advisable to leave the stomach tube in place continuous^. The drugs indicated were morphine, to relieve pain Viagra Generic Launch Date and shock ; strychnine, to stimulate the heart and for its effect on the vasomotor nerv- ous system (in the hope that it might bring about contraction of the distended stomach) : and eserinc, on account of its efficiency in inducing peristalsis. The last named was especially indicated if the in- testines appeared to be involved. He had never resorted to any of the surgical procedures which had been suggested, as any operation would neces- Viagra Generic Launch Date