. International record of medicine . , or the unionof the gall-bladder to a neighboring coil of intestine, is onewhich at the present time is performed at one etherization,and Kappeler has had five cases with no deaths. In fistula of the gall-bladder, where the secretion is inlarge amount, whether traumatic, ulcerative, or operative,in permanent closure of the common duct (except where dueto stone), and in perforation of the common duct into theabdominal cavity, it is an operation by far the best and withthe slightest mortality. In patients who are weak at the time of the operation itis to be
. International record of medicine . , or the unionof the gall-bladder to a neighboring coil of intestine, is onewhich at the present time is performed at one etherization,and Kappeler has had five cases with no deaths. In fistula of the gall-bladder, where the secretion is inlarge amount, whether traumatic, ulcerative, or operative,in permanent closure of the common duct (except where dueto stone), and in perforation of the common duct into theabdominal cavity, it is an operation by far the best and withthe slightest mortality. In patients who are weak at the time of the operation itis to be replaced by a provisory cholecystostomy. Wherestone obstruction exists in the common duct, choledocho-lithectomy or lithothripsy must replace it. I do not intend to enter into the minute details of theoperative treatment, such as the method of suture, the anti-sepsis, and the application of dressings, for I do not con-sider them as in any way differing from what is daily prac-ticed bv all surgeons. I do think, however, that the sur-. WHEftT, Rye - ^ \v & Graham 6reau ■** Potatoes Crackers Dried Beef Cod Fish Salmon July 30, 1892.] WOODBURY: DIGESTIVE FERMENT OF THE CARICA PAPAYA. 11^ geon often neglects to make use of certain points which arenot only valuable but often decide the success or failure ofthe operation. Mention will only be made of such as appearto me to be not infrequently overlooked. A very carefuland even prolonged clinical observation in diseases of thischaracter should be considered absolutely necessary to in-sure good results. Too great attention can not be given to a close and re-peated investigation of the patient in general, and especiallyof the different excretions and secretions. Of such, no ob-servation is more important than the luemorrhages into theskin, stomach, and intestine. This is of a special impor-tance in those suffering from chronic jaundice and well-marked cholwmia. Where such haemorrhages exist, <any op-erative interference is to be avo
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Keywords: ., bookcentury1800, bookdecade1860, booksubjectmedicine, bookyear186
