Modern surgery, general and operative (1919) (14781808494)

Identifier: modernsurgerygen1919daco (find matches)

Title: Modern surgery, general and operative

Year: 1919 (1910s)

Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933

Subjects: Surgery, Operative

Publisher: Philadelphia : Saunders

Contributing Library: Columbia University Libraries

Digitizing Sponsor: Open Knowledge Commons

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ust examine for evidence of syphilis. If there isno history of injury, syphilis, tuberculosis, scarlatina, variola, or prolongedvomiting, and the patient is over forty years of age, the indications point tocancer rather than to cicatricial stenosis. The easy passage of a bougie whenthe patient is anesthetized shows that spasm is the cause, and not organicdisease. Narrowing due to external pressure (compression stenosis) is markedby positive symptoms of the causative disease.^ Compression stenosis mayarise in goiter, vetebral growths, enlargement of the heart, glandular enlarge-ment, peri-esophageal abscess, aneurysm, lordosis, and mediastinal tumor(Kohler, in Brit. Med. Jour., Oct. 19, 1912). Treatment.—Thiosinamin is given by some physicians, but I have neverseen it accomplish the slightest good. Telleky- recommends it in old scarswithout inflammation. He makes a 15 per cent, alcoholic solution and in-jects from 3 2 to I syringeful at a dose, throwing the fluid beneath the skin be-

Text Appearing After Image:

FiG. 678.—Symondss short tube for intubation of the esophagus (Morrow). tween the scapulae. He uses twenty doses in the course of two weeks. Gradualdilatation through the mouth is a method employed for at least a time in almostevery case. It is the method of choice when it can be carried out, and usuallyit can be carried out. Begin with the largest flexible bougie which will easilypass. Warm the bougie, oil it, pass it gently, and hold it in position forseveral minutes, prolonging the time of retention of the bougie as treatment pro-gresses. Pass an instrument every second or third day, gradually increasing thesize. Chevalier Jackson is impressed with the danger of blind dilatation. Heinaugurates dilatation by using instruments through the tube of the esophago-scope. Plummer (Northwestern Lancet, Jan. 15, 1912) dwells on the dangerof using bougies, especially in cancerous constriction, and advocates the useof the string guide of Mixter in tight or tortuous stenoses. Mixters plan ist

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1919

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